March 2012

Volume 17, Issue 1

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Original Research - A Randomized Controlled Trial of a Multifaceted Integrated Complementary-Alternative Therapy for Chronic Herpes Zoster-Related Pain by Fred Hui, MD, CCFP, Eleanor Boyle, PhD, Eugene Vayda, MD, FRCP, Richard H. Glazier, MD, MPH, FCFP

Abstract

INTRODUCTION: Our objective was to determine whether a three-week complementary and alternative medicine (CAM) approach integrating several therapies from Traditional Chinese Medicine (TCM) along with neural therapy (injection of 1% procaine as local anesthesia) reduces the level of unresolved pain associated with herpes zoster. METHODS: The design was a randomized controlled clinical trial in a community-based primary care clinic in Toronto, Ontario. We studied individuals 18 years of age and older with a confirmed diagnosis of herpes zoster of at least 30 days duration and with at least moderate postherpetic neuralgia pain (≥4) on a 10-point Likert scale. The CAM therapies used were acupuncture, neural therapy (1% procaine injection as a local anesthetic), cupping and bleeding, and TCM herbs. An immediate treatment group (n=32) received the CAM intervention once daily, five days per week, for three weeks. A wait-list (delayed treatment) group (n=27) was used as a control and received the same treatment starting three weeks after randomization. This three-week time period, when one group was receiving active CAM treatment and the other was not, was used as basis of comparison for treatment effects between groups. Pain, quality of life, and depression were measured at baseline, and three, six, and nine weeks post-randomization. Patients were followed for up to two years. RESULTS: Participants had a mean age of 69.8 years (SD=11.1) and had had herpes zoster-related pain for a median of 4.8 months (range: 1 month to 15 years). The immediate treatment and control groups had similar pain levels at baseline (treatment = 7.5; control = 7.8; p=0.5; scores based on the 10-point Likert pain scale). At three weeks post-randomization (i.e., after the immediate treatment group completed treatment) pain scores differed significantly (treatment = 2.3; control = 7.2; p< 0.001). The observed reduction in pain in the immediate treatment group was maintained at nine weeks and at long-term follow-up (one to two years later). The delayed treatment (control) group also had significant reductions in pain after their integrated CAM treatment was completed. CONCLUSION: The described CAM protocol was associated with significantly reduced sub-acute and chronic post-herpes zoster neuralgia pain within three weeks of initiating treatment. Improvements persisted for up to two years. (Altern Med Rev 2012;17:57-68)

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