Analgesia in Herpes Zoster and Postherpetic Neuralgia

描述(申请人提供)：带状疱疹是一种常见且疼痛的疾病 由水痘-带状疱疹重新激活引起的神经系统疾病 病毒。急性感染痊愈后持续的带状疱疹疼痛是 被称为带状疱疹后神经痛(PHN)，是一种慢性疼痛综合征，通常 对所有治疗都难治。预计PHN的患病率将会增加 在接下来的几十年里，带状疱疹和 随着人口老龄化，患PHN的风险都会增加。尽管有研究表明 改善治疗仍在继续，多达一半的患者没有 目前正在得到缓解。出于这个原因，制定干预措施 预防PHN将大大减少残疾、痛苦和使用 卫生保健资源。基于风险因素的研究成果 对于PHN及其病理生理机制，可以假设 抗病毒和止痛联合治疗在感染后尽快开始 -带状疱疹的发病将降低患PHN的风险。这样做的具体目的是 计划拨款是为临床试验制定方案和程序。 来检验这一假设。拟议的审判将有以下主要内容 目标：主要目的将是检验PHN的风险 在接受抗病毒药物治疗的带状疱疹患者中减少一半 阿片类止痛剂与接受抗病毒药物治疗的患者的比较 和配对的安慰剂。对这一假说的支持将对 对带状疱疹患者的治疗及导致实质性 PHN患病率的下降。第二个主要目标将是 由拟议的审判完成的是确定是否启动 慢性神经病理性疼痛的中枢机制可以通过减轻 剧烈的疼痛。这个问题的答案将提供重要的信息。 关于持续性疼痛的机制，并对其有重要意义 预防。

DESCRIPTION (provided by applicant): Herpes zoster is a common and painful neurological disease that is caused by reactivation of the varicella-zoster virus. Herpes zoster pain that persists after healing of the acute infection is termed postherpetic neuralgia (PHN), a chronic pain syndrome that is often refractory to all treatment. The prevalence of PHN is expected to increase substantially in the coming decades because the incidence of herpes zoster and the risk of PHN will both increase as the population ages. Although research to improve treatment is continuing, as many as half of all patients do not currently obtain relief. For this reason, the development of interventions that prevent PHN would lead to major reductions in disability, distress, and use of health care resources. On the basis of the results of research on risk factors for PHN and its pathophysiologic mechanisms, it can be hypothesized that combined antiviral and analgesic treatment begun as soon as possible after the -onset of herpes zoster will reduce the risk of PHN. The specific aim of this planning grant is to develop the protocol and procedures for a clinical trial to test this hypothesis. The proposed trial will have the following major objectives: The primary aim will be to test the hypothesis that the risk of PHN is reduced by half in herpes zoster patients treated with an antiviral agent and an opioid analgesic compared with patients treated with the antiviral agent and matching placebo. Support for this hypothesis would have a major impact on the treatment of patients with herpes zoster and lead to a substantial reduction in the prevalence of PHN. A second major aim that will be accomplished by the proposed trial is determining whether the initiation of central mechanisms of chronic neuropathic pain can be prevented by attenuating acute pain. The answer to this question will provide important information about mechanisms of prolonged pain and have major implications for its prevention.