Der Einfluss chronischer Schmerzen als Komorbidität auf den klinischen Verlauf bei Patienten mit akuter Herpes-Zoster-Infektion
The Influence of Chronic Pain as a Comorbidity on the Clinical Course in Patients with Acute Herpes Zoster Infection
by Felix Brandebusemeyer
Date of Examination:2021-06-29
Date of issue:2021-06-07
Advisor:Prof. Dr. Frank Petzke
Referee:Prof. Dr. Jorge Alberto Frank
Referee:Prof. Dr. Martin Oppermann
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Abstract
English
Objective: Pre-existing chronic pain has been associated with severe postoperative pain. To analyze the impact of chronic pain on non-surgical acute pain a cohort of patients with acute herpes zoster was studied. Methods: Consecutive patients who needed hospitalization because of an acute zoster infection were characterized and compared according to their pain history. Pain intensity, pain-related functional restrictions, analgesic consumption, psychological distress and pain pressure threshold were evaluated on day 1, 4, 7 and on the day of discharge. Three and six months after discharge from hospital patients were interviewed by telephone about the aforementioned parameters. Results: 59 patients were included; 25 patients (42.4%) had pre-existing chronic pain. These patients had more severe acute zoster pain on all assessment days during hospital stay, were more restricted in function and had more side effects that could be associated with pain management. There were no differences in analgesic consumption. Patients with pre-existing chronic pain had a longer inpatient stay. In patients without chronic pain only the amount of analgesic consumption was associated with the severity of zoster pain. In contrast, in patients with chronic pain physical health and the extent of neuropathic pain characteristics were associated with the intensity of zoster-related acute pain. The follow-up survey showed that patients who developed post-herpetic neuralgia (PHN) had poorer physical and mental health and showed more neuropathic pain characteristics. PHN patients also consumed higher amounts of analgesics. The intensity of the PHN was associated with the duration of the inpatient treatment and the maximum intensity of the zoster pain on the day of discharge. Conclusions: Patients with chronic pain had higher intensity of zoster-related acute pain. Furthermore, they showed more pain-related dysfunction and needed longer hospitalization than patients without chronic pain. These results go along with findings for acute postoperative pain. Due to the fact that only hospitalized patients were included in this study the results might not be transferred completely on patients with an acute herpes zoster infection in outpatient care.
Keywords: chronic pain; herpes zoster; post-herpetic neuralgia; neuropathic pain