Skip to main navigation menu Skip to main content Skip to site footer

Short communication

Vol. 142 No. 0304 (2012)

TENS – an alternative to antiviral drugs for acute herpes zoster treatment and postherpetic neuralgia prevention

  • M Kolsek
DOI
https://doi.org/10.4414/smw.2012.13229
Cite this as:
Swiss Med Wkly. 2012;142:w13229
Published
15.01.2012

Abstract

QUESTIONS UNDER STUDY:To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of Herpes zoster (HZ), and prevention of postherpetic neuralgia (PHN) compared with antiviral drugs. PHN is frequent complication of HZ and may last for months, its treatment isn’t very successful. Nonpharmacological regimens for treatment of HZ and prevention of PHN haven’t been evaluated.

METHODS: Retrospective observational study of medical records of patients of three family physicians in Health centre Litija, Slovenia was done. 109 of 6613 patients on their lists had HZ from 1999 to 2008. 102 medical records were analyzed (6 could not be reached; one patient with corneal HZ was excluded).

RESULTS: Four treatment groups were compared: only TENS therapy, only antiviral drug, antiviral drug and TENS, no therapy (neither antiviral drug or TENS). All groups were similar with respect to demographic characteristics of patients with HZ. Patients treated only with TENS had no PHN, 28.6% of patients treated with antiviral drugs had PHN. Less analgesic drugs have been prescribed to patients treated only with TENS.

CONCLUSION: Study suggests TENS may be safe adjunct or even alternative to antiviral drugs for treatment of acute HZ. It looks that TENS may be at least as good as antiviral drugs for treatment of HZ, and it may be better in reducing and preventing PHN – such conclusion would necessitate controlled, prospective study. Use of TENS provided pain relief and resolution of skin lesions with no higher rate of other HZ complications compared to antiviral therapy.

References

  1. Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44(Suppl 1):S1–26.
  2. Haanpää M, Laippala P, Nurmikko T. Pain and Somatosensory Dysfunction in Acute Herpes Zoster. Clin J Pain. 1999;15(2):78–84.
  3. Chapman RS, Cross KW, Fleming DM. The incidence of shingles and its implications for vaccination policy. Vaccine. 2003;21:2541–7.
  4. Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The Incidence of Herpes Zoster in a United States Administrative Database. J Gen Intern Med. 2005;20(8):748–53.
  5. Opstelten W, van Essen GA, Moons KGM, an Wijck AJM, Schellevis FG, Kalkman CJ, et al. Do herpes zoster patients receive antivirals? A Dutch national survey in general practice. Fam Pract. 2005;22(5):523–8.
  6. Sočan M, Novak-Mlakar D, Ogrin-Rehberger P. Pasavec – dostopni epidemiološki podatki v Sloveniji (Herpes zoster – available epidemiological data in Slovenia). Zdrav Vestn. 2006;75:555–60.
  7. Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother. 2004;5(3):551–9.
  8. Tyring S, Barbarash RA, Nahlik JE, Cunningham A, Marley J, Heng M, et al. Famciclovir for the treatmnet of acute herpes zoster: effects on acute disease and postherpetic neuralgia. Ann Intern Med. 1995;123:89–96.
  9. Volpi A, Gross G, Hercogova J, Johnson RW. Current Management of Herpes Zoster: The European View. [Review]. Am J Clin Dermat. 2005;6(5):317–25.
  10. Breuer J, Scott F, Leedham-Green M. Postherpetic neuralgia. Pathogenesis of postherpetic neuralgia should be determined. BMJ. 2001;322(7290):860.
  11. Lancaster T, Silagy C, Gray S. Primary care management of acute herpes zoster: systematic review of evidence from randomised controlled trials. Br J Gen Pract. 1995;45:39–45.
  12. Opstelten W, Mauritz JW, de Wit NJ, van Wijck AJ, Stalman WA, van Essen GA. Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract. 2002;19:471–5.
  13. Gross G, Schofer H, Wassilew S, Friese K, Timm A, Guthoff R, et al. Herpes zoster guideline of the German Dermatology Society (DDG). J Clin Virol. 2003;26(3):277–89.
  14. Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61(8):2437–48.
  15. Alper BS, Lewis PR. Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia? J Fam Pract. 2000;49:225–64.
  16. Jung BF, Johnson RW, Griffin DR, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004;62(9):1545–51.
  17. Ahmed HE, Craig WF, White PF, Ghoname ESA, Hamza MA, Gajraj NM, et al. Percutaneous electrical nerve stimulation: an alternative to antiviral drugs for acute herpes zoster. Anesth Analg. 1998;87(4):911–4.
  18. Chen CJ, Yu HS. Acupuncture, electrostimulation, and reflex therapy in dermatology. Dermat Ther. 2003;16(2):87–92.
  19. Christo PJ, Hobelmann G, Maine DN. Post-herpetic neuralgia in older adults: evidence-based approaches to clinical management. Drugs Aging. 2007;24(1):1–19.
  20. Niv D, Maltsman-Tseikhin A. Postherpetic Neuralgia: The Never-Ending Challenge. [Review]. Pain Practice. 2005;5(4):327–40.
  21. Wu CL, Raja SN. An update on the treatment of postherpetic neuralgia. J Pain. 2008;9(Suppl 1):S19–30.
  22. Oxman MN, Levin MJ, Johnson GR, Schmader SE, Straus LD, Gelb RD, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–84.
  23. Ahčin M, Kristan M. Zdravljenje zostra s transkutano električno blokado (Treatment of zoster with transcutaneus nervous block). Zdrav Vestn. 1987;6(12):459–62.
  24. Bassino P, Bandini M, Dal Tio R. Treatment of pain in cases of acute herpes zoster and post-herpetic neuralgia. Minerva Anestesiologica. 1985;51(1-2):45–50.
  25. Nathan PW, Wall PD. Treatment of post-herpetic neuralgia by prolonged electrical stimulation. Br Med J. 1974;3:645–7.
  26. Brett AS. What is the incidence of shingles? Journal Watch. 2007;6(11):3.
  27. Wareham DW, Breuer J. Herpes zoster. BMJ. 2007;334(7605):1211–5.
  28. Cunningham AL, Dworkin RH. The management of post-herpetic neuralgia. BMJ. 2000;321:778–9.
  29. Dworkin RH, White R, O’Connor AB, Baser O, Hawkins K. Healthcare costs of acute and chronic pain associated with a diagnosis of herpes zoster. J Am Geriat Soc. 2007;55(8):1168–75.
  30. Petek-Šter M, Švab I. Kako raziskovati multimorbidnost v družinski medicini? (How to research multimorbidity in general practice?) Zdrav Var. 2009;48:51–61.