Short summary

Post-herpetic neuralgia (PHN) is a neuropathic pain syndrome occurring after an outbreak of herpes zoster (HZ) or "shingles". It is a very common and painful condition affecting many people. Today, no effective treatment excists. Some people have reported a positive effect using acupunture to reduce the pain. The studies performed on the subject have been of low quality and there have been no randimized controlled trials (RCT) comparing treatment with a placebo-treatment. We aim to perform a RCT on 40 subjects, comparing acupunture with a sham treatment. 

Rationale

Post herpetic neuralgia (PHN) is a neuropathic pain syndrome occurring after an outbreak herpes zoster (HZ) or "shingles". It is caused by the reactivation of the varicella zoster virus (VZV). The risk of developing PHN after HZ is reported as being between 5% to 30% and the pain is reported to last up to 10 years. Clinically, the disease is characterized by a painful, unilateral vesicular eruption, which usually occurs with limited dermatomal distribution. Pain is the predominant symptom in all phases of the disease, being reported in up to 90% of patients. Most patients with PHN describes three types of pain: a constant deep, aching or burning pain, a paroxysmal, lancinating pain, and allodynia. Treatment of PHN is complex and the neuropathic pain is exceptionally drug-resistant. Several broad recommendations on treatment of the neuropathic pains have been published. There is, however, currently, no internationally accepted guideline of treating PHN. Treatment consists of topically and systemically administered medication. The present standard of care is not very effective and new treatments are needed. Some patients and physicians have reported a pain-relieving effect, using acupuncture for PHN. Previous studies have confirmed the potential effect of acupuncture on acute herpetic pain, but the studies performed on chronic post-herpetic neuralgia are inconclusive and of low scientific quality. A recent, large, meta-analysis by Wang et al. summarised all data on acupuncture and PHN. Their conclusion was that the available data was too small and inconclusive and of poor quality, due to methodolic defects in the available studies, to conclude on the effect. The recommend a large-scale, high quality randomized clinical trial (RCT), to investigate the possible effect

We therefore aim to perform the first RCT investigating the possible effect of acupuncture on post-herpetic neuralgia. The participants will be divided into two groups. Group A, the intervention group will receive dry-needling in the area of pain. Group B, the control group will receive a sham procedure. 

Description of the cohort

The cohort consists of men and women suffering from chronic post-herpetic pain, with pain localised in the skin below neck-level 

Data and biological material

The data collected is mainly questionnaires. We will be using three questionnaires:

? Pain (Numeric VAS-Scale) 0-10.

? Neuropathic Pain. Questionnaire: Neuropathic Pain Symptom Inventory scale, translated and validated into Danish. 

? Quality of Life. Questionnaire: SF-36. 

We will also collect data from journals regarding:

?  Previous medical history

?  Use of analgesics 

Collaborating researchers and departments

Dep. Plastic- and Reconstructive Surgery, Odense University Hospital

• Professor Jens Ahm Sørensen, MD, PhD
• Jørn Bo Thomsen, MD, PhD

Dep. of Plastic Surgery, Hospital of South West Jutland

• Michael Rose, MD

Publications associated with the project

Sollie M, Pind R, Madsen CB, Sørensen JA. Acupuncture (superficial dry-needling) as a treatment for chronic postherpetic neuralgia - a randomized clinical trial. British Journal of Pain. June 2021. doi:10.1177/20494637211023075