Acupuncture For Postherpetic Neuralgia

Acupuncture for postherpetic neuralgia (Protocol)
Wang P, Zhao J, Wu T
This is a reprint of a Cochrane protocol, prepared and maintained by The Cochrane Collaboration and published in The Cochrane
Library 2009, Issue 2
http://www.thecochranelibrary.com

Copyright 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
TABLE OF CONTENTS
HEADER . . . . . . . . . .
ABSTRACT . . . . . . . . .
BACKGROUND . . . . . . .
OBJECTIVES . . . . . . . .
METHODS . . . . . . . . .
ACKNOWLEDGEMENTS
. . .
REFERENCES . . . . . . . .
APPENDICES . . . . . . . .
HISTORY . . . . . . . . . .
CONTRIBUTIONS OF AUTHORS
DECLARATIONS OF INTEREST .
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[Intervention Protocol]
Acupuncture for postherpetic neuralgia

Peng Wang2 , Jiping Zhao1 , Taixiang Wu3
1 Acupuncture
and Moxibustion Department, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine, Beijing
, China. 2 Acupuncture and Moxibustion Department, Dongzhimen Hospital affiliated to Beijing University of Chinese Medicine,
Beijing, China. 3 Chinese Cochrane Centre, Chinese EBM Centre, West China Hospital, Sichuan University, Chengdu, China
Contact address: Jiping Zhao, Acupuncture and Moxibustion Department, Dongzhimen Hospital affiliated to Beijing University of
Chinese Medicine, 5 Haiyuncang , Beijing , 1007000, China. zjp7883@sina.com. (Editorial group: Cochrane Neuromuscular Disease
Group.)
Cochrane Database of Systematic Reviews, Issue 2, 2009 (Status in this issue: New)
DOI: 10.1002/14651858.CD007793
This version first published online: 15 April 2009 in Issue 2, 2009. (Help document - Dates and Statuses explained)
This record should be cited as: Wang P, Zhao J, Wu T. Acupuncture for postherpetic neuralgia. Cochrane Database of Systematic
Reviews 2009, Issue 2. Art. No.: CD007793. DOI: 10.1002/14651858.CD007793.
ABSTRACT
This is the protocol for a review and there is no abstract. The objectives are as follows:
The objective of this systematic review is to assess whether acupuncture is more efficacious than no treatment, placebo or sham
acupuncture, and whether acupuncture is more efficacious than routine Western drugs for PHN.

BACKGROUND
Definition
Postherpetic neuralgia (PHN), the most common complication
of herpes zoster, is classified as pain persisting longer than three
months after the onset of the rash (Baron 2004). The rash itself is
due to activation of latent varicella-zoster virus (VZV). Pain sometimes starts before the onset of the herpetic rash. For some people,
it is the only symptom. It may persist for months or years after the
disappearance of the rash (Volmink 1996). PHN is caused by persistent nerve damage which outlasts the skin lesions (Oaklander
2008).
Postherpetic neuralgia occurs especially in those with more severe acute pain and rash (Johnson 2007). Approximately 20% of
people older than 50 years of age continue to report pain for six
months (Tenser 2005). The symptoms are continuous or intermittent spontaneous pain and stimulus-evoked pain (Schmader
1998). The pain causes considerable physical and psychosocial
morbidity (Tenser 2005) producing insomnia, fatigue, anorexia,
depression, anxiety, social withdrawal and interference with daily
activities (Schmader 1998; Schmader 2002; Sra 2004).
Burden of disease
Despite antiviral therapy being used during the acute period, a
substantial number of people still suffer PHN (Tenser 2005). The
incidence of PHN varies from 8 to 24% in all patients with recovery after the acute attack of herpes zoster (van Seventer 2006). The
number increases to 25 to 50% of people older than 50 (Schmader
2002) and to 27 to 68% of those older than 60 (Schmader 1998).
The incidence of herpes zoster varies from 0.8 (van Seventer 2006)
to 4.8 cases per 1000 people per year (Antonelli 1991; Chidiac
2001). Thus, 800,000 people suffer from herpes zoster each year in
the US (Schmader 2002). The incidence rises to more than 1% of
individuals older than 80 (Volpi 2005) and about 50% of people
older than 90 years (Johnson 2004). Among inpatients older than
50 years, the incidence is 78% (Gil 2004). A second attack may
occur in approximately 6% of those reaching 90 years (Johnson
2004).
The annual cost of therapy for herpes zoster is EUR 7 million in
Spain (Gil 2004), 47.6 million in England and Wales (Edmunds
2001), and US$ 80 million (US$ 280 per herpes zoster case) in
the US (Goldman 2005). In east London, the average overall cost
of herpes zoster is 524 per patient in the first six months. The
medical costs are highest in people over 65 and the societal costs
are highest in those under 65 years (Scott 2006).
Management
Drug therapy
Postherpetic neuralgia is difficult to treat because a uniformly effective therapy is not available although various treatments have
been tried (Schmader 1998; Matsumoto 2002).
Antiviral drugs, such as acyclovir, brivudine, valaciclovir (He 2007;
Wassilew 2003) and famciclovir (Sandy 2005) are available for
acute herpes zoster (Sra 2004). There is no evidence that corticosteroids reduce the incidence of PHN (He 2008).
Tricyclic antidepressants (TCAs) are considered as first line therapy
for PHN (Johnson 2004; Saarto 2007). A low-dose of the drugs
used for acute herpes zoster may prevent PHN (Mounsey 2005).
Some antiepileptics are used as second line therapy (Johnson 2004;
Wiffen 2005 (a); Wiffen 2005 (b)) including pregabalin (Zareba
2005; Sabatowski 2004), gabapentin (Curran 2003; Stacey 2003;
Wiffen 2005 (c)) and oxcarbazepine (Criscuolo 2004).
There are some other drugs used for people with PHN, including topical anaesthetics such as the lidocaine patch 5% (
Davies 2004; Khaliq 2007), local administrations including peppermint oil (containing 10% menthol) (Davies 2002), capsaicin
cream ( Mounsey 2005), clonidine hydrochloride ointment (
Meno 2001), aspirin dissolved in chloroform (Kochar 1998) and
prostaglandin E1 dissolved in Vaseline (Tamakawa 1999), epidural or intrathecal sympathetic blocks with various injections (
Kumar 2004), intrathecal corticosteroids (Santee 2002), tramadol
(Boureau 2003), oxycodone (Watson 1998), divalproex sodium
(valproic acid and sodium valproate in molar ratio 1:1) (Kochar
2005), dextromethorphan, a non-selective NMDA receptor antagonist (Suzuki 1996;Mizuno 2001), and the Chinese herb Ganoderma lucidum (Hijikata 1998).
Zoster vaccine has been approved for adults over 60 years by the
United States Food and Drug Administration. Live zoster vaccine
decreases the frequency of PHN by 66.5% (Kockler 2007).
Physical therapy
Transcutaneous electrical nerve stimulation (Johnson 2004), electrical spinal cord stimulation (SCS) (Harke 2002), endoscopic
transthoracic sympathicotomy (ETS) (Matsumoto 2002) and iontophoresis therapy (Ozawa 1999) have all been tried with variable
results (Matsumoto 2002).
Acupuncture for the treatment of PHN
Acupuncture is less expensive and has fewer side effects than drug
therapy (Coghlan 1992). Various acupuncture techniques are used
for PHN as follows:
1. Filiform needle or body acupuncture. This is used most
widely in acupuncture therapy and is usually now made
of stainless steel. For PHN, needling methods mean inserting the needles into the local points known as Ashi
acupoints around the region of pain and supplementary
acupoints usually in the limbs. The selection of supplementary acupoints is based on symptoms, examination of the tongue and pulse according to the theory of
Chinese Traditional Medicine. The angle and depth of
insertion are different for different people.

2. Fire needle. The diameter of the fire needle is bigger

than that of the filiform needle. It is pricked quickly
into the skin surface about one to two millimetres deep
after burning to red in the flame and then withdrawn
quickly.
3. Three-edged needle or plum blossom needle and bloodletting. The three-edged needle is shaped with a thick
and round handle, a triangular body and a sharp tip.
The plum blossom needle, also named dermal needle or
Qixingzhen, is a combination with seven short small
three-edged needles. Both of the needles are used for
superficial blood vessel pricking to cause bleeding.
4. Cupping. This is a therapy in which a glass jar is attached
to the skin surface to cause local congestion through
the removal of the air in the jar created by introducing
heat in the form of an ignited material. The therapy is
usually used after pricking with the fire needle or plum
blossom needle to assist the bloodletting.
5. Point injection. This therapy uses the syringe to inject
liquid medicine into the acupoints or the positive sensitive spot to cure the disease. The medicine includes
both Western and Chinese Traditional Medicine.
6. Auricular acupuncture. The ear is considered as a hologram of the body in Traditional Chinese Medicine. It is
divided into approximately 100 regions that correspond
with different parts of the body. Stimulating certain sensitive points with needles or other tools is thought to
heal many diseases.
7. Electro-acupuncture. This combines needles and electrical stimulation by sending a small amount of electric
current to the needle after insertion of the needles and
arrival of qi to treat diseases.
A more detailed introduction to acupuncture and pictures can be
obtained from: http://en.acutimes.com.
Rationale for undertaking this review
Acupuncture is most widely and successfully used in Western
medicine to treat chronic and intractable pain syndromes (Reilly
2000). All of the acupuncture methods above are used to treat
PHN, alone or alongside each other. There have been many trials of acupuncture for treating PHN. However, the evidence for
the efficacy of acupuncture is not strong due to limitations in
the design of acupuncture trials. Most of the present trials have
been conducted with known sources of bias: for example they have
been open, single blind, with no treatment controls, and a small
sample size. The designs of the outcome measurement are often
not rigorous. Therefore, people may be confused as single trials of
acupuncture produce contradictory conclusions.
For example, the conclusion of a single blind randomised controlled study was that there is no difference between the auricular
and body acupuncture group and the placebo group in pain relief for people with PHN (Lewith 1983). Whereas, another randomised control trial concluded that filiform needle therapy was
more effective than the oral painkiller novoltan (Zhu 2004).

To date, there have been no systematic reviews on acupuncture
therapy for PHN.
OBJECTIVES
The objective of this systematic review is to assess whether
acupuncture is more efficacious than no treatment, placebo or
sham acupuncture, and whether acupuncture is more efficacious
than routine Western drugs for PHN.
METHODS
Criteria for considering studies for this review

Types of studies
Double-blind randomised controlled trials (RCTs) will be included in this systematic review with no language or publication
type restriction.
Types of participants
Inclusion criteria:
1. People with PHN, regardless of age, gender and race

2. PHN is diagnosed by characteristic pain, occurring at
the sites of rashes, along the innervations region of a
cranial or spinal nerve;
3. Pain persisting at least three months after the onset of
acute shingles;
4. Pain with or without local hyperpigmentation.
Exclusion criteria:
1. People with herpes zoster ophthalmicus or herpes zoster

oticus;
2. Pregnant females;
3. People with a serious condition of the cardiovascular,
liver, renal, endocrine , immune system or haematological systems;
4. People with a malignancy.
Types of interventions
We consider using simultaneously one or more than one modalities
of acupuncture as acupuncture as a whole. The different types of
acupuncture include:
1. Filiform needle
2. Fire needle
3. Three-edged needle
4. Plum blossom needle
5. Auricular acupuncture
6. Electro-acupuncture

7.
8.
9.
10.
Point injection
Laser acupuncture
Moxibustion
Cupping (only the cupping used immediately after
acupuncture such as fire needle, three-edged needle,
plum blossom needle, especially on the pricked area for
bloodletting will be included).
Trials with the following comparisons will be included:
1. Acupuncture versus no treatment;
2. Acupuncture versus placebo or sham acupuncture;
3. Acupuncture versus Western medicine, of which efficiency is supported by evidence or recommended by
guidelines, such as gabapentin and TCAs;
4. Acupuncture plus Chinese herbs (or physical therapy)
versus the same Chinese herbs (or physical therapy).
Types of outcome measures
Primary outcomes
1. Pain relief by 50% or more on a visual analogue scale

(VAS) or Liekert scale after one month.
Secondary outcomes
1. Pain relief by at least 50% on VAS or Liekert scale after

three months.
2. Change in quality of life measured with the physical
and mental summary scores of the Short Form 36 or
other validated quality of life scales after three months.
3. Weekly healthcare costs from randomisation to three
months after entry into the trial.
4. Adverse events including serious adverse events which
are those which require hospitalisation, are life-threatening or are fatal, adverse events which lead to cessation
of treatment and all adverse events.
Search methods for identification of studies

Electronic searches
We will search the Cochrane Neuromuscular Disease Group Trials Register for randomised trials using the following search terms
postherpetic neuralgia, PHN, herpes zoster, shingles, and
acupuncture, electroacupuncture, meridians, moxibustion,
acupoint, plum blossom needle, wrist ankle needle, threeedged needle, fire needle, cupping, bloodletting. We will adapt
this strategy to search MEDLINE (from 1966 to the present),
EMBASE (from 1980 to the present), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library,
most recent issue), Chinese Biomedical Database (from 1979 to
the present) and www.Clinicaltrials.gov. The search strategies for
MEDLINE and EMBASE can be found in Appendix 1 and
Appendix 2.
Searching other resources
We will handsearch the Chinese Journals in which we think we

might find RCTs or controlled clinical trials (CCTs) relevant to our
study. Then we will ask stringent questions about randomisation,
concealment of allocation, observer and participant blinding and
completeness of follow up through telephone or email.
We will review the bibliographies of the randomised trials identified, contact the authors and known experts in the field and approach pharmaceutical companies to identify additional published
or unpublished data.
Data collection and analysis

Selection of studies
Two review authors will independently scrutinise titles and abstracts of references retrieved from the databases. The same two
review authors will obtain the full text of all potentially relevant
studies, and then independently select eligible trials according to
the inclusion criteria. Review authors will not be blinded to the
names of the authors, institutions or journal of publication. We
will resolve disagreements by discussion between the two review
authors.
Data extraction and management
Two review authors will extract data independently on study characteristics including inclusion and exclusion criteria of participants, baseline characteristics of participants, interventions and
outcomes using a self-developed data extraction form. We will obtain missing and insufficient data from the study authors whenever possible. One review author will enter the data into Review
Manager (RevMan) 5 and a second review author will check the
data entry.
Assessment of risk of bias
Two review authors will independently assess the methodological
quality as follows:
An assessment of risk of bias will be made on all included studies
and a risk of bias table will be completed according to guidelines in
the Cochrane Handbook of Systematic Reviews of Interventions
(Higgins 2008). If randomised controlled trials are identified we
will assess randomisation sequence generation, allocation concealment, blinding (participants, personnel and outcome assessors),
incomplete outcome data, selective outcome reporting and other
sources of bias. We will then make a judgement on each of these
criteria relating to the risk of bias using Yes indicating low risk of
bias, No high risk of bias and Unclear unclear or unknown risk
of bias.
We will resolve disagreement by discussion with reference to a
third review author if necessary.
Data analysis
We will analyse data with the Cochrane statistical software package RevMan. We will express results as risk ratios (RR) with 95%
confidence intervals (CI) or risk differences (RD) with 95% CI for

dichotomous outcomes and weighted mean differences (WMD)

with 95% CI or standard mean difference (SMD) with 95% CIs
for continuous outcomes. We will use SMD when different measures are used to quantify the same clinical outcome.
Assessment of heterogeneity
If there is significant clinical heterogeneity among studies, we will
perform analysis of subsets of trials. We will use the Chi2 test and
the I2 statistic to quantify heterogeneity across trials in the same
subgroup. If there is no evidence of heterogeneity we will pool the
studies using a fixed-effect model. If significant heterogeneity is
found, we will attempt to explore possible reasons for it and solve
the problem by allocating the studies with clinical or methodological heterogeneity which may have been ignored at the beginning
to different subsets. If the heterogeneity is still present, we will use
a random-effects model. If there are not sufficient studies (i.e. less
than two studies in every subset), we will give the results of all
studies one by one instead of performing meta-analysis.
Assessment of reporting biases

We will use a funnel plot to investigate the possibility of publication bias. Effect size will be plotted against study size in a graphical display, which will give some indication whether or not some
studies with particular study size and effect size combination have
not been published or located.
Subgroup analysis
For this review, the subgroups will be as follows:
1. People less than 60 years old versus those 60 years or
older.
2. People with a duration of post-herpetic neuralgia less
than one year versus those with a duration more than
one year
Sensitivity analysis
ACKNOWLEDGEMENTS
We will undertake a sensitivity analysis by repeating the calculation

after omitting the studies that have low scores on individual quality
items.
We thank Professor Wu Taixiang, the Chinese Cochrane Centre,

the Co-ordinator and Cochrane Neuromuscular Disease Group,
for advice in writing this protocol.
REFERENCES
Additional references
Antonelli 1991
Antonelli MA, Moreland LW, Brick JE. Herpes zoster in patients
with rheumatoid arthritis treated with weekly, low-dose methotrexate. The American Journal of Medicine 1991;90(3):2958.
Baron 2004
Baron R. Post-herpetic neuralgia case study: optimizing pain control.
European Journal of Neurology 2004;11(Suppl 1):311.
Boureau 2003
Boureau F, Legallicier P, Kabir-Ahmadi M. Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled
trial. Pain 2003;104(1-2):32331.
Chidiac 2001
Chidiac C, Bruxelle J, Daures JP, Hoang-Xuan T, Morel P, Leplege A,
et al.Characteristics of patients with herpes zoster on presentation to
practitioners in France. Clinical Infectious Diseases 2001;33(1):629.
Coghlan 1992
Coghlan CJ. Herpes zoster treated by acupuncture. The Central
African Journal of Medicine 1992;38(12):4667.
Criscuolo 2004
Criscuolo S, Auletta C, Lippi S, Brogi F, Brogi A. Oxcarbazepine
(Trileptal) monotherapy dramatically improves quality of life in two
patients with postherpetic neuralgia refractory to carbamazepine and
gabapentin. Journal of Pain and Symptom Management 2004;28(6):
5356.
Curran 2003
Curran MP, Wagstaff AJ. Gabapentin: in postherpetic neuralgia.
CNS Drugs 2003;17(13):97582.
Davies 2002
Davies SJ, Harding LM, Baranowski AP. A novel treatment of postherpetic neuralgia using peppermint oil. The Clinical Journal of Pain
2002;18(3):2002.
Davies 2004
Davies PS, Galer BS. Review of lidocaine patch 5% studies in the
treatment of postherpetic neuralgia. Drugs 2004;64(9):93747.
Edmunds 2001
Edmunds WJ, Brisson M, Rose JD. The epidemiology of herpes
zoster and potential cost-effectiveness of vaccination in England and
Wales. Vaccine 2001;19(23-24):307690.
Gil 2004
Gil A, San-Martin M, Carrasco P, Gonzalez A. Epidemiology of severe
varicella-zoster virus infection in Spain. Vaccine 2004;22(29-30):
394751.
Goldman 2005
Goldman GS. Cost-benefit analysis of universal varicella vaccination
in the U.S. taking into account the closely related herpes-zoster epidemiology. Vaccine 2005;23(25):334955.
Harke 2002
Harke H, Gretenkort P, Ladleif HU, Koester P, Rahman S. Spinal
cord stimulation in postherpetic neuralgia and in acute herpes zoster
pain. Anesthesia and Analgesia 2002;94(3):694700.

He 2007
Li Q, He L, Zhang Q, Zhou M, Zhou D. Antiviral treatment for preventing postherpetic neuralgia (Protocol). Cochrane
Database of Systematic Reviews 2007, Issue 4.
[DOI:
10.1002/14651858.CD006866]
He 2008
He L, Zhang D, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database of Systematic Reviews 2008, Issue 1.[Art. No.: CD005582. DOI:
10.1002/14651858.CD005582.pub2]
Higgins 2008
Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 5.0.0 [updated February 2008]. The
Cochrane Collaboration, 2008. Available from www.cochranehandbook.org.
Hijikata 1998
Hijikata Y, Yamada S. Effect of Ganoderma lucidum on postherpetic
neuralgia. The American Journal of Chinese Medicine 1998;26(3-4):
37581.
Johnson 2004
Johnson RW, Whitton TL. Management of herpes zoster (shingles)
and postherpetic neuralgia. Expert Opinion on Pharmacotherapy
2004;5(3):5519.
Johnson 2007
Johnson RW, Wasner G, Saddier P, Baron R. Postherpetic neuralgia:
epidemiology, pathophysiology and management. Expert Review of
Neurotherapeutics 2007;7(11):158195.
Khaliq 2007
Khaliq W, Alam S, Puri N. Topical lidocaine for the treatment of postherpetic neuralgia. Cochrane Database of Systematic Reviews 2007, Issue 2.[Art. No.: CD004846. DOI:
10.1002/14651858.CD004846.pub2]
Kochar 1998
Kochar DK, Agarwal RP, Joshi A, Kumawat BL. Herpes zoster and
post-herpetic neuralgia-a clinical trial of aspirin in chloroform for
anodyne. The Journal of the Association of Physicians of India 1998;
46(4):33740.
Matsumoto 2002
Matsumoto I, Oda M, Shintani H. Use of endoscopic transthoracic
sympathicotomy in intractable postherpetic neuralgia of the chest.
Chest 2002;122(2):7157.
Meno 2001
Meno A, Arita H, Hanaoka K. Preliminary report: the efficacy of
clonidine hydrochloride ointment for postherpetic neuralgia. Masui
2001;50(2):1603.
Mizuno 2001
Mizuno J, Sugimoto S, Ikeda M, Ikeda M, Machida K, Mikawa
Y. Usefulness of epidural administration of ketamine for relief of
postherpetic neuralgia. Masui 2001;50(8):9047.
Mounsey 2005
Mounsey AL, Matthew LG, Slawson DC. Herpes zoster and postherpetic neuralgia: prevention and management. American Family
Physician 2005;72(6):107580.
Oaklander 2008
Oaklander AL. Mechanisms of pain and itch caused by herpes zoster
(shingles). Journal of Pain 2008;9(1 suppl 1):S108.
Ozawa 1999
Ozawa A, Haruki Y, Iwashita K, Sasao Y, Miyahara M, Sugai J, et
al.Follow-up of clinical efficacy of iontophoresis therapy for postherpetic neuralgia (PHN). The Journal of Dermatology 1999;26(1):1
10.
Reilly 2000
Reilly MP. Clinical applications of acupuncture in anesthesia practice.
CRNA: the clinical forum for nurse anesthetists 2000;11(4):1739.
Saarto 2007
Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane
Database of Systematic Reviews 2007, Issue 4.[Art. No.: CD005454.
DOI: 10.1002/14651858.CD005454.pub2]
Sabatowski 2004
Sabatowski R, Galvez R, Cherry DA, Jacquot F, Vincent E,
Maisonobe P, et al.Pregabalin reduces pain and improves sleep and
mood disturbances in patients with post-herpetic neuralgia: results
of a randomised, placebo-controlled clinical trial. Pain 2004;109(12):2635.
Sandy 2005
Sandy MC. Herpes zoster: medical and nursing management. Clinical Journal of Oncology Nursing 2005;9(4):4436.
Kochar 2005
Kochar DK, Garg P, Bumb RA, Kochar SK, Mehta RD, Beniwal R, et
al.Divalproex sodium in the management of post-herpetic neuralgia:
a randomized double-blind placebo-controlled study. QJM : Monthly
Journal of the Association of Physicians 2005;98(1):2934.
Santee 2002
Santee JA. Corticosteroids for herpes zoster: what do they accomplish?. American Journal of Clinical Dermatology 2002;3(8):51724.
Kockler 2007
Kockler DR, McCarthy MW. Zoster vaccine live. Pharmacotherapy
2007;27(7):10139.
Schmader 1998
Schmader K. Postherpetic neuralgia in immunocompetent elderly
people. Vaccine 1998;16(18):176870.
Kumar 2004
Kumar V, Krone K, Mathieu A. Neuraxial and sympathetic blocks
in herpes zoster and postherpetic neuralgia: An appraisal of current
evidence. Regional Anesthesia and Pain Medicine 2004;29(5):454
61.
Schmader 2002
Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. The Clinical
Journal of Pain 2002;18(6):3504.
Lewith 1983
Lewith GT, Field J, Machin D. Acupuncture compared with placebo
in post-herpetic pain. Pain 1983;17(4):3618.
Scott 2006
Scott FT, Johnson RW, Leedham-Green M, Davies E, Edmunds WJ,
Breuer J. The burden of Herpes Zoster: A prospective population
based study. Vaccine 2006;24(9):130814.

Sra 2004
Sra KK, Tyring SK. Treatment of postherpetic neuralgia. Skin Therapy Letter 2004;9(8):14.
Stacey 2003
Stacey BR, Glanzman RL. Use of gabapentin for postherpetic neuralgia: results of two randomized, placebo-controlled studies. Clinical
Therapeutics 2003;25(10):2597608.
Suzuki 1996
Suzuki T, Kato J, Saeki S, Ogawa S, Suzuki H. Analgesic effect of
dextromethorphan for postherpetic neuralgia. Masui 1996;45(5):
62933.
Tamakawa 1999
Tamakawa S, Tsujimoto J, Iharada A, Ogawa H. Treatment of postherpetic neuralgia by topical application of prostaglandin E1-vaseline mixture--a single blind controlled clinical trial. Masui 1999;48
(3):2924.
Tenser 2005
Tenser RB, Dworkin RH. Herpes zoster and the prevention of postherpetic neuralgia: beyond antiviral therapy. Neurology 2005;65(3):
34950.
van Seventer 2006
van Seventer R, Sadosky A, Lucero M, Dukes E. A cross-sectional
survey of health state impairment and treatment patterns in patients
with postherpetic neuralgia. Age and Ageing 2006;35(2):1327.
Volmink 1996
Volmink J, Lancaster T, Gray S, Silagy C. Treatments for postherpetic
neuralgia-a systematic review of randomized controlled trials. Family
Practice 1996;13(1):8491.
Volpi 2005
Volpi A, Gross G, Hercogova J, Johnson RW. Current management
of herpes zoster: the European view. American Journal of Clinical
Dermatology 2005;6(5):31725.
Wassilew 2003
Wassilew SW, Wutzler P, Brivddin Herpes Zoster Study Group. Oral
brivudin in comparison with acyclovir for herpes zoster: a survey
study on postherpetic neuralgia. Antiviral Research 2003;59(1):57
60.
Watson 1998
Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a
randomized trial in postherpetic neuralgia. Neurology 1998;50(6):
183741.
Wiffen 2005 (a)
Wiffen P, Collins S, McQuay H, Carroll D, Jadad A, Moore A.
Anticonvulsant drugs for acute and chronic pain. Cochrane Database
of Systematic Reviews 2005, Issue 3.[Art. No.: CD001133. DOI:
10.1002/14651858.CD001133.pub2]
Wiffen 2005 (b)
Wiffen PJ, McQuay HJ, Moore RA. Carbamazepine for acute and
chronic pain. Cochrane Database of Systematic Reviews 2005, Issue 3.
Wiffen 2005 (c)
Wiffen PJ, McQuay HJ, Edwards JE, Moore RA. Gabapentin
for acute and chronic pain.
Cochrane Database of Systematic Reviews 2005, Issue 3.[Art. No.: CD005452. DOI:
10.1002/14651858.CD005452]
Zareba 2005
Zareba G. Pregabalin: a new agent for the treatment of neuropathic
pain. Drugs of Today 2005;41(8):50916.
Zhu 2004
Zhu T. Clinical observation on post herpetic neuralgia treated by
acupuncture. Hebie Journal of Traditional Chinese Medicine 2004;26
(5):3645.
Indicates the major publication for the study
APPENDICES
Appendix 1. OVID MEDLINE search strategy

1 randomized controlled trial.pt.
2 controlled clinical trial.pt.
3 randomized.ab.
4 placebo.ab.
5 drug therapy.fs.
6 randomly.ab.
7 trial.ab.
8 groups.ab.
9 or/1-8
10 (animals not (animals and humans)).sh.
11 9 not 10
12 Acupuncture/
13 exp Acupuncture Therapy/

14 acupuncture.mp.
15 (acupoint$ or electroacupuncture or electro-acupuncture).mp.
16 (fire needl$ or warming needl$).tw.
17 plum blossom needl$.tw.
18 three edged needl$.tw.
19 wrist ankle needl$.tw.
20 elongated needl$.mp.
21 pricking blood.mp.
22 percussopunctator.mp.
23 acupressure.mp.
24 cupping.mp.
25 meridians.tw.
26 moxibustion.tw.
27 bloodletting.tw.
28 or/12-27
29 exp herpes zoster/
30 shingles.mp.
31 neuralgia, postherpetic/
32 PHN.tw.
33 herpes zoster.tw.
34 (postherpetic neuralgia or post-herpetic neuralgia).tw.
35 or/29-34
36 11 and 28 and 35
Appendix 2. OVID EMBASE search strategy

1 Randomized Controlled Trial/
2 Clinical Trial/
3 Multicenter Study/
4 Controlled Study/
5 Crossover Procedure/
6 Double Blind Procedure/
7 Single Blind Procedure/
8 exp RANDOMIZATION/
9 Major Clinical Study/
10 PLACEBO/
11 Meta Analysis/
12 phase 2 clinical trial/ or phase 3 clinical trial/ or phase 4 clinical trial/
13 (clin$ adj25 trial$).tw.
14 ((singl$ or doubl$ or tripl$ or trebl$) adj25 (blind$ or mask$)).tw.
15 placebo$.tw.
16 random$.tw.
17 control$.tw.
18 (meta?analys$ or systematic review$).tw.
19 (cross?over or factorial or sham? or dummy).tw.
20 ABAB design$.tw.
21 or/1-20
22 human/
23 nonhuman/
24 22 or 23
25 21 not 24
26 21 and 22
27 25 or 26
28 exp acupuncture/
29 (electroacupuncture or electro-acupuncture).ti,ab.
30 (acupuncture$ or acupoint or acupressure).mp.
31 plum blossom needl$.ti,ab.
32 three edged needl$.ti,ab.
33 wrist ankle needl$.ti,ab.
34 (fire needl$ or warming needl$).ti,ab.
35 meridians.ti,ab.
36 moxibustion.ti,ab.
37 cupping.ti,ab.
38 bloodletting.ti,ab.
39 or/28-38
40 exp herpes zoster/
41 shingles.mp.
42 postherpetic neuralgia/
43 herpes zoster.ti,ab.
44 (postherpetic neuralgia or post-herpetic neuralgia).ti,ab.
45 phn.tw.
46 or/40-45
47 27 and 39 and 46
HISTORY
Protocol first published: Issue 2, 2009
CONTRIBUTIONS OF AUTHORS
Peng Wang designed the study and wrote the protocol from the first to the final version.
Jiping Zhao commented on and revised the protocol from the aspect of acupuncture treatment.
Taixiang Wu offered guidance and suggestions about the technology through the whole writing process of the protocol. He also revised
the protocol drafts.
DECLARATIONS OF INTEREST
Peng Wang and Jiping Zhao are acupuncture doctors based in hospital. Taixiang Wu who has not been trained in acupuncture, is an
expert in evidence-based medicine in university. We have no potential conflicts of interest.


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