vitamin-b-12 and Neuralgia--Postherpetic

Postherpetic neuralgia (PHN) is the most distressful complication of herpes zoster. PHN results in an impaired quality of life and higher healthcare utilization. Vitamin B12 has been proven to be effective in pain relief for various conditions.. We conducted a systematic review and a meta-analysis to evaluate the efficacy of vitamin B12 supplementation in PHN patients.. PubMed, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov registry were searched. Randomised control trials evaluating the efficacy and safety of vitamin B12 in PHN patients were selected. Eligible trials were abstracted and assessed for the risk of bias by two reviewers, and the results of pain indicators in the selected trials were analysed.. Four trials including 383 participants were published between 2013 and 2016. Compared with the placebo group, the Vitamin B12 group exhibited a significant decrease in the Numeric Rating Scale score, with a mean difference of -4.01 (95% confidence interval = -4.70 to -3.33). Vitamin B12 administration improved the quality of life of PHN patients with moderate quality evidence and significantly decreased the number of patients using analgesics.. Vitamin B12 appears to be an attractive complementary therapy for PHN patients. Further investigation is needed before conclusive recommendations can be made.

Topics: Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; Vitamin B 12

The ophthalmic branch of the trigeminal nerve is one of the most frequently involved sites of postherpetic neuralgia. A single-center randomized controlled study was conducted to evaluate the efficacy of local methylcobalamin injection for subacute ophthalmic herpetic neuralgia (SOHN).. One hundred and five patients with a pain score of 4 or greater were randomized to receive a combination of methylcobalamin and lidocaine via local injection (LM group, n = 35), intramuscular methylcobalamin and local lidocaine injection (IM group, n = 35), and oral methylcobalamin tablet and lidocaine local injection (OM group, n = 35) for 4 weeks. Multilevel mixed modeling was employed to examine treatment responses.. Pain scores were reduced in all groups, but this reduction was significantly greater in the LM group (6.7 at baseline vs. 2.8 at endpoint) when compared with systemic administration (IM group 6.8 vs. 4.9, OM group 6.7 vs. 5.1). Clinically relevant reduction of pain (>30%) was seen in 91% of patients in the LM group, a significantly greater proportion than in the systemic groups (66% IM group, 57% OM group). Analgesic use reduced significantly in the LM group (94% at baseline vs. 6% at endpoint) but not in systemic groups (IM group 97% vs. 86%, OM group 94% vs. 80%). Health-related quality of life was higher in the LM group than in the systemic groups. In mixed modelling, increased age was associated with a lower response to methylcobalamin.. This study indicates that local injection of methylcobalamin produces significant pain relief from SOHN and is superior to systemic administration.

Topics: Administration, Cutaneous; Administration, Oral; Aged; Analgesics; Anesthetics, Local; Female; Herpes Zoster Ophthalmicus; Humans; Injections, Intramuscular; Lidocaine; Male; Middle Aged; Nerve Growth Factors; Neuralgia, Postherpetic; Quality of Life; Vitamin B 12

To determine the therapeutic efficacy of combined methylcobalamin and lidocaine for acute ophthalmic herpetic neuralgia (AOHN).. Based on the onset, patients with AOHN (n = 98) were randomly allocated into groups A (≤ 3 days) and B (4 to 7 days) and then subdivided into control (A0, B0; received intramuscular methylcobalamin in addition to local lidocaine injection) and treatment (A1, B1; received local injection of the methylcobalamin and lidocaine combination for 14 days) groups. Treatment efficacy was assessed based on rash healing time, alteration of pain intensity, and interference with quality of life. Multilevel modeling and survival analysis were performed.. The time (hours) to start and full opening of the affected eye and the time (hours) to start and full crusting were significantly reduced in both treatment groups (P < 0.05 vs. controls). The mean pain scores in A1 (2.6 ± 0.7) and B1 (1.2 ± 0.8) decreased significantly compared with those in A0 (7.0 ± 1.7) and B0 (5.6 ± 1.9), and the difference between the two therapeutic strategies significantly increased over time. The median minimum intervention time was 6 days in B1 and 11 days in A1. The incidence of postherpetic neuralgia (PHN) was 2.04% at 3 months.. Methylcobalamin combined with lidocaine mediated detumescence and improved cutaneous healing of the affected area, as well as a significant and sustained analgesic effect on AOHN. The incidence of PHN was also significantly decreased. Local methylcobalamin intervention within 4 to 7 days of onset may be an effective therapeutic option for AOHN.

Topics: Aged; Anesthetics, Local; Female; Herpes Zoster Ophthalmicus; Humans; Incidence; Lidocaine; Male; Middle Aged; Neuralgia, Postherpetic; Quality of Life; Treatment Outcome; Vitamin B 12

To determine the efficacy of methylcobalamin combined with lidocaine for acute herpetic neuralgia.. Randomized controlled trial with longitudinal analysis.. The authors recruited 204 patients (>50 years) with T5-10 dermatomal acute herpetic neuralgia with rash onset within 7 days. Patients were divided into two groups based on the time of onset: immediate-early (IE, 1-3 days) and early stage (ES, 4-7 days) groups and then subdivided randomly into control (IE-Ctl, ES-Ctl) and treatment (IE-Tr, ES-Tr) groups.. Control groups received intramuscular methylcobalamin in addition to local lidocaine injection, while treatment groups received local methylcobalamin combined with lidocaine injection for 14 days. Treatment efficacy was assessed based on rash healing time, alteration in pain intensity, and interference with quality of life. Multilevel mixed modeling and survival analysis were employed to examine treatment responses.. There was no significant difference in the rash healing time between IE and ES. The mean pain scores in IE-Tr (2.4 ± 0.7) and ES-Tr (1.3 ± 0.7) decreased significantly compared with those in the control groups. The median satisfactory response time was 6 days in ES-Tr and 11 days in IE-Tr. The benefit ratio for ES-Tr versus IE-Tr was 14.94. The subjects in IE-Tr and ES-Tr had higher quality of life scores (81.2 ± 6.9 vs 88.3 ± 8.6, respectively) than those in the control groups. The incidence of postherpetic neuralgia was 1.1% at 3 months.. Local methylcobalamin combined with lidocaine, optimally administered within 4-7 days of onset, may be an effective therapeutic option for acute herpetic neuralgia.

Topics: Acute Disease; Aged; Anesthetics, Local; Drug Therapy, Combination; Female; Humans; Injections, Subcutaneous; Lidocaine; Longitudinal Studies; Male; Middle Aged; Neuralgia, Postherpetic; Prospective Studies; Vitamin B 12

Postherpetic neuralgia (PHN) is a commonest and difficult-to-manage complication of Herpes zoster. This comparative study included 140 cases of PHN admitted in the department of dermatology in Renmin Hospital of Wuhan University, Wuhan, China, from March 2014 to February 2015, divided into a control and a study group. In addition to the combination of antiviral, analgesic, and neurotrophic agents given to the control group, additional ganglioside GM1 was given to patients in the study group. Pain assessment was performed at the time of admission, and then on the third, seventh and tenth day of treatment, on both groups, using a 10 cm visual analogue scale (VAS). There was a significant statistical difference between the pain VAS score of the two groups, on the seventh day (3.73 ±1.66 vs. 3.03 ±1.86, p=0.024) and on the tenth day (3.25 ±1.78 vs. 2.20 ±1.59, p=0.006) of treatment. The number of patients who have good /and complete response (37.5%) were largely higher in the study group than those in the control group (15%, p < 0.05). This finding demonstrates that the administration of ganglioside GM1 may potentially serve as a neoadjuvant therapy to reduce the severity and duration of pain in PHN patients.

Topics: Administration, Intravenous; Adult; Analgesics; Antiviral Agents; China; Female; G(M1) Ganglioside; Herpes Zoster; Humans; Injections, Intramuscular; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Thiamine; Treatment Outcome; Vitamin B 12; Vitamin B Complex

The aim of this study was to explore the efficacy of transcutaneous electrical nerve stimulation (TENS) with locally injected cobalamin in relieving pain and improving activities of daily living in patients with postherpetic neuralgia.. Ninety patients (≥50 yrs old) with postherpetic neuralgia with a pain score of 4 or greater were randomized to receive TENS and local injections of cobalamin or lidocaine or a combination of cobalamin and lidocaine for 8 wks. Treatment efficacy was assessed on the basis of worst pain severity, global impression of change, activities of daily living, and quality-of-life.. Time × group interaction, group differences, and time effect on worst pain at each follow-up point were statistically significant (P < 0.05) among the groups. In the group receiving TENS and local injection of cobalamin and in the group receiving TENS with a combination of cobalamin and lidocaine, the mean ± SD pain scores were 4.0 ± 1.4 and 4.1 ± 1.2 at endpoint, 28 and 26 patients achieved pain reduction of 30% or greater, and 14 and 10 perceived worst pain of 3 or less, respectively. The activities of daily living and quality-of-life data at the study endpoint showed significant benefits in the group receiving TENS and local injection of cobalamin and in the group receiving TENS and a combination of cobalamin and lidocaine (P < 0.05). In the group receiving TENS and local injection of lidocaine, the mean ± SD pain score was 6.1 ± 1.2 at the endpoint relative to baseline (P < 0.05), and only six patients achieved pain reduction of 30% or greater.. TENS in combination with local cobalamin injection has a significant analgesic effect.

Topics: Activities of Daily Living; Aged; Aged, 80 and over; Anesthetics, Local; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Injections, Subcutaneous; Lidocaine; Male; Middle Aged; Neuralgia, Postherpetic; Neuroprotective Agents; Quality of Life; Transcutaneous Electric Nerve Stimulation; Visual Analog Scale; Vitamin B 12

This study explored the efficacy of local methylcobalamin injection in relieving pain and improving the quality of life among subjects with subacute herpetic neuralgia.. A single-center, randomized controlled trial of local methylcobalamin injection was performed.. Ninety-eight subjects (age, ≥ 50 years) with unilateral, dermatomal pain ≥ 4 related to herpes zoster on the torso lasting for 30 days after onset of rash were enrolled.. Subjects were randomized to receive local methylcobalamin injection (N = 33), oral methylcobalamin (N = 33), or subcutaneous 1.0% lidocaine injection (N = 32) for 4 weeks. Worst pain severity, global impression of change, continuous spontaneous pain, paroxysmal pain, allodynia, paresthesia, interference with activities of daily living, and quality of life were assessed after 28-day treatment period.. Time per group interaction and group difference on overall pain at each follow-up point were statistically significant (P < 0.001) among groups. In the injected methylcobalamin group, the overall pain (P < 0.001), continuous spontaneous pain (P < 0.05), paroxysmal pain (P < 0.05), and allodynia (P < 0.05) revealed a significant effect at each follow-up point as compared with the other groups. Twenty subjects achieved pain reduction ≥ 50%, 24 perceived worst pain ≤ 3, 24 stopped using analgesics at end point; activities of daily living and quality of life improved significantly as compared with the other groups (P < 0.001). Although both of the other groups showed a significant response after the 14-day treatment (P < 0.001) compared with the baseline, oral methylcobalamin did not provide any significantly pain relief (P > 0.05).. Local methylcobalamin injection was not only efficacious in relieving pain, but also appears to be tolerable and a potential choice of treatment for subacute herpetic neuralgia.

Topics: Aged; China; Comorbidity; Drug-Related Side Effects and Adverse Reactions; Female; Humans; Injections, Subcutaneous; Male; Neuralgia, Postherpetic; Pain Measurement; Prevalence; Quality of Life; Risk Factors; Treatment Outcome; Vitamin B 12