After
the primary varicella-zoster virus infection, there is an occurrence of acute
skin disease called herpes zoster (HZ).
Intravenously
administered ascorbic acid did not relieve acute herpes zoster (HZ) pain; but
is effective for reducing the incidence of postherpetic neuralgia (PHN).
After the primary varicella-zoster virus infection, there is an occurrence of acute skin disease called herpes zoster (HZ). Within the dorsal root ganglia, the virus remains latent and becomes re-energized by the factors lessening the cell-mediated immunity, traveling down the sensory root ganglia to cause acute pain and vesicular eruption. Herpes zoster can cause pain during the acute phase and results in various complications including postherpetic neuralgia (PHN), encephalomyelitis, and neural paralysis, even after treatment. Postherpetic neuralgia persists for 1 to 6 months even after improvement in cutaneous outbreak. Its occurrence differs with definition, ranging from 8%∼15%. It significantly impairs the patient’s quality of life because of physical disability and mental disorders. The treatment of HZ aims to a quick recovery of skin lesions, reduction in the intensity and duration of acute pain, and decreasing the frequency of problems like PHN. Antiviral drugs, analgesic drugs, lower level laser therapy, and preventive vaccines are used as a conventional approach for acute pain and PHN; while the treatment of HZ remains a challenge. Vitamin C deficiency has been marked in patients with viral infections and has been found to play an important role in the pathogenesis of herpes infection and incidence of PHN. Various studies have confirmed the positive effects with the intravenous (IV) injection of vitamin C in treating acute pain from HZ and PHN. However, arguments continue about the suitability of using vitamin C in the treatment of HZ.
Rationale behind research:
Objective:
To evaluate the efficacy of intravenously administrated vitamin C on acute pain and its preventive effects on PHN in patients with HZ.
NOTE: Patients who received any antiviral medications from a different hospital and were discharged within 5 days, took analgesic anti-inflammatory drugs to control pain before admission, or were not followed-up after discharge were excluded.
Study outcomes:
Outcomes
Figure
1: Changes in the severity of pain between Vitamin C treatment group and
control group
The study
results showed that the incidence of PHN was significantly decreased in vitamin
C treatment group. Unlike previous reports, no significant change in acute pain
within 4 weeks of hospitalization was observed between the vitamin C treatment
and control groups, when pain score was compared according to time intervals.
However, statistically significant differences were observed after the eighth
week and continued thereafter.
Consistent
with previous studies, it was found that low-dose of vitamin C was efficient in
the treatment of PHN. As this study involved patients treated with IV antiviral
therapy, it can be considered that antiviral treatment may offset the effect of
vitamin C. Moreover, changes in overall pain with respect to time showed
statistically significant difference between the two groups, and pain was more
effectively controlled in the vitamin C treatment group than in the control
group. In the vitamin C treatment group, changes in the pain score over time by
all variables without sex did not show statistically significant differences.
The women showed significant decrease in pain score. Perhaps, the more they are
sensitive to pain at first, they are considered more responsive to the
treatment.
In this
study, the results did not reflect a significant decrease in acute pain, unlike
previous studies, but the treatment was effective in preventing PHN. Also,
because of the significant changes in pain over time, we argue that this may be
a safe treatment for prevention of PHN and HZ-related pain without major side
effects.
Various treatments have been
introduced to date, but when conventional treatment is unresponsive or
management is difficult, IV injection of vitamin C can be used as an effective
treatment method to control HZ-related pain and symptoms.
Ann Dermatol Vol. 28, No. 6, 2016
A Study of Intravenous Administration of Vitamin C in the Treatment of Acute Herpetic Pain and Postherpetic Neuralgia
Min Sung Kim et al.
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