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Revista Ecuatoriana de Ciencia, Tecnología e
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Código ISSN 2588-0551
Martínez M., Romo H., Quality
of life in post-herpetic neuralgia
in the dermatology department of
Hospital Luis Vernaza. Original
Article. INSPILIP. 2023; Vol. 7,
Num. 23.
Scientic magazine INSPILIP.
Volume 7, number 23,
September - December 2023.
The author declares to be free of any
personal or commercial association
that may involve a conict of interest
in connection with the article, as
well as having respected the ethical
principles of research, such as having
requested authorizations from the
institution where the study was
conducted, permission to use the data,
informed consents and in the case of
observational studies and clinical
trials, authorization from a CEISH,
ARCSA, Environment, among
others, according to the category. In
addition, the license to publish images
of the person or persons appearing in
the manuscript. Therefore, INSPILIP
is not responsible for any aectation
to third parties, neither INSPI as
publishing entity, nor the Editor, the
responsibility of the publication is of
absolute responsibility of the authors.
Patricio Vega Luzuriaga
EDITOR-IN-CHIEF
iD
María Martínez Guillén
a
, * martinezguillenmaria1@gmail.com
iD
Howard Romo Cevallos
b, c
, howardromo@yahoo.com
a. DERM Dermatological Center, Omnihospital, Guayaquil, Ecuador.
b. Omnihospital, Guayaquil, Ecuador.
C. Luis Vernaza Hospital, Guayaquil, Ecuador.
*Correspondence: María Mercedes Martínez Guillen Email: martinezguillenmaria1@gmail.
com
Identication of the responsibility and contribution of the authors: The authors declare
having contributed to the original idea, methodological part, writing of the draft and writing of
the article (MM, RH).
Date of Entry: 23/6/2023.
Date of Aproval: 5/9/2023.
Date of Publication: 5/9/2023.
Quality of life in post-herpetic neuralgia in the dermatology department of Hospital Luis
Vernaza
Calidad de vida en neuralgia postherpética en el servicio de dermatología del Hospital Luis
Vernaza
Original Article
Open Access
Abstract
Citation
Introduction: Shingles (HZ) is the result of the reactivation of the varicella zoster virus.
The main complication of HZ is post-herpetic neuralgia (PHN), pain that appears in
the aected dermatome 3 months after the resolution of the cutaneous lesions. Despite
the limited evidence, PHN signicantly inuences the patient's quality of life (QL),
aecting their functional capacity, emotional state and work capacity in the active
population. The objective of the present investigation was to evaluate the quality of
life in NPH. Previous studies have not been done in this institution and statistics on
the subject are nil in Ecuador. Materials and Methods: The study was descriptive,
observational, retroprospective with a non-experimental and transversal level. The
universe consisted of 141 patients with a diagnosis of PHN treated at the outpatient
clinic of the dermatology service of the Luis Vernaza hospital during the period from
January 1 to December 31, 2016, with a sample of 92 patients, who underwent an
interview and a physical examination, using a data sheet that included the DN4 and
EQ-5D-5L questionnaires. Excel tables were used to record the data. Results: Of
the total of 92 patients who participated in the study, tingling was the most frequent
symptom. Regarding the symptomatic load related to QL in PHN, the friction pain
and numbness with P values of 0.00 show a strong statistical signicance followed by
a puncture with a P value of 0.03. The scatter plot to assess the level of PHN severity
and its relation to quality of life indicates that QL is related to neuropathic pain (NP).
The average DN4 was 4/10. 82 % of cases, with or without neuropathic pain, had a
better QL; 18 %, accompanied by NP, reported aectation in their QL. The average
index value of the EQ5D5L was 0.814. Conclusions: It was concluded that the quality
of life is aected in patients with postherpetic neuralgia.
Keywords: Herpes zoster, Post-herpetic neuralgia, Neuropathy, Quality of life.
DOI: 10.31790/inspilip.v7i23.538
Scientific magazine INSPILIP - Volume 7 - Number 23 - September - December 2023
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Revista Ecuatoriana de Ciencia, Tecnología e
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Código ISSN 2588-0551
Resumen
Introducción: El herpes zóster (HZ) es el
resultado de la reactivación del virus de la
varicela zóster. La principal complicación del
HZ es la neuralgia post-herpética (NPH), dolor
que aparece en el dermatoma afectado 3 meses
después de la resolución de las lesiones cutáneas.
A pesar de la limitada evidencia, la NPH inuye
signicativamente en la calidad de vida (CV) del
paciente que la padece, afectando su capacidad
funcional, estado emocional y capacidad de
trabajo en la población activa. El objetivo de
la presente investigación fue evaluar la calidad
de vida en la NPH. Estudios previos no se han
realizado en esta institución y la estadística sobre
el tema es nula en Ecuador. Materiales y Métodos:
Se realizó un estudio descriptivo, observacional,
retroprospectivo con nivel no experimental y
transversal. El universo lo constituyeron 141
pacientes con diagnóstico de NPH atendidos en
la consulta externa del servicio de dermatología
del hospital Luis Vernaza durante el período 1 de
enero a 31 de diciembre de 2016, con una muestra
de 92 pacientes, a los cuales se les realizó una
entrevista y un examen físico, mediante una hoja
recolectora de datos que incluyó los cuestionarios
DN4 y EQ-5D-5L. Para registrar los datos se
usaron tablas de Excel. Resultados: Del total
de 92 pacientes que participaron en el estudio,
el hormigueo fue el síntoma más frecuente. Con
respecto a la carga sintomática relacionada con CV
en NPH, el dolor por roce y el entumecimiento con
valores P de 0.00 presentan una fuerte signicancia
estadística seguidos del pinchazo con valor P 0.03.
El diagrama de dispersión para valorar el nivel
de gravedad de NPH y su relación con la calidad
de vida, indica que la CV sí se relaciona con el
dolor neuropático (DN). El promedio del DN4 fue
de 4/10. El 82 % de los casos, acompañándose o
no de dolor neuropático, presentaron una mejor
CV; el 18 %, acompañándose de DN, reportó
afectación en su CV. El valor índice promedio del
EQ5D5L fue 0,814. Conclusiones: Se concluyó
que la calidad de vida sí se ve afectada en los
pacientes aquejados con neuralgia postherpética.
Palabras clave: Herpes zóster, Neuralgia
post-herpética, Neuropatía, Calidad de vida.
Introduction
Infection by Herpes zoster is a neuro-cutaneous
disease caused by reactivation of the Varicella
Zoster Virus. It is recognized to be an important
cause of morbidity, especially among the elderly
(1). After an episode of herpes zoster, pain of
more than three months duration is regarded
as post-herpetic neuralgia (PHN). This disease
aects the quality of life of people presenting
the disease; most aected areas are capacity to
function, emotional state, and ability to work in
the active population (2) (3). Execution of this
investigation had as a goal to associate the clinical
characteristics of post-herpetic neuralgia with the
analysis of impact on quality of life in patients that
present this disease.
Methodology
An observational, descriptive, retrospective and
transversal study was conducted. Population
consisted of patients that had consultations at the
o-patient clinic of the Dermatology service of
the Hospital Luis Vernaza. The studied period was
January through December of 2016 and a universe
of 141 patients was obtained; the size of the
sample was calculated with a condence interval
of 95%, 5% margin of error and heterogeneity of
50%, obtaining 104 patients of which 12 declined
participation, for a total of 92 patients who signed
the informed consent.
Among the inclusion criteria was taken into
account: patients of age equal or older than
eighteen, who have been diagnosed with
post-herpetic neuralgia.
As to the data collection, an interview and a physical
examination were performed. The answers where
provided by the patients regarding the timing and
disease evolution, previous antiviral or neuropathic
treatment, as well as a detailed questionnaires
where implemented: Douleur Neuropathique en 4
Questions (DN4), which is formed by 10 items,
allows to distinguish by scales the dimensions
of nociceptive and neuropathic pain. Another
scale used was the European Quality of Life - 5
Dimensions - 5 Levels of Severity (EQ-5D-5L)
which is useful to assess Quality of Life in
ve dimensions (Mobility, Self-Care, habitual
activities, pain/discomfort, anxiety/depression).
To register the data, a statistical analysis software
was used. Results are presented in frequency and
percentage tables.
Results
Out of the 92 patients (N) in the study, 58%
(53N) were female and 42% (39N) were male.
Of the total of patients with PHN (Post-herpetic
neuralgia) 57% (52N) are to be included within
the age range between 50 and 79 years of age,
27% (25N) are between 20 and 49 years of age
and 16% (15 N) were older than 80 years old. 71%
(65 N) did receive antiviral treatment and 29%
(27 N) did not receive any antiviral treatment. All
of the patients did receive previous neuropathic
treatment.
Out of the total of patients, 57% (52N) presented
a range of evolution of post-herpetic neuralgia
DOI: 10.31790/inspilip.v7i23.538
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Revista Ecuatoriana de Ciencia, Tecnología e
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Código ISSN 2588-0551
spanning from 13 to 24 months, in 25% (23 N) the
duration was greater than 24 months and 18% (17
N) had a duration and evolution in between 1 and
12 months.
Out of the total of symptoms that present themselves
in PHN, 68 N presented tingling sensation, 53 N
burning sensation, 27 N pinching sensation, 22 N
pain by touch, 17 N painful cold, 17 N numbing
sensation, 15 N touch hypoesthesia and pinching
hypoesthesia. (View Table 1)
In relation to impact on quality of life: out of 22 N
who presented pain by touch, 11 cases showed an
eect on quality of life, with a P value of 0.00; in
17 N with numbing sensation, 9 had their quality
of life aected with a P value of 0.00; out of 27 N
with pinching pain, 10 cases presented an eect
in quality of life with a P value of 0.03; out of 68
N with numbing sensation, 17 cases presented
an eect on their quality of life with a P value of
0.07; in 55 N with stinging sensation, 15 presented
alterations in quality of life with a P value of 0.08;
in 17 N with painful cold, 4 cases had aectation
in their quality of life with a P value of 0.55; in
54 N with electrical discharge, 11 cases presented
alteration in quality of life, with a P value of 0.57;
in 53 N with burning sensation, 13 cases had
aectation of quality of life with a P value of 0.81.
(View table 2)
When using a dispersion diagram with Pearson’s
correlation, using the total score in the DN4
questionnaires in the X axis, and EQ-5D-5L in
the Y axis, a cloud of points was obtained, which
turned around a line’s axis, showing a negative
correlation between both scores. (View Table 3).
Out of the total of 92 patients diagnosed with NPH
and evaluated by the questionnaire EQ-5D-5L: 38
cases presented a score between 1 and 0.89 (better
quality of life), 28 obtained a value between 0.89
and 0.75 (good quality of life), 11 N presented a
score between 0.75 and 0.61, 11 N had a score
of 0.61 and 0.47 (quality of life aected), 1 N
presented a score between 0.33 and 4.47 (quality
of life aected) and 3 N obtained values between
0.33 and 0.19 (the worst scores for quality of life).
Mean index value was 0.814.
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Revista Ecuatoriana de Ciencia, Tecnología e
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Discussion
Out of the 92 total patients, 58% were female and
42% were male; American and European literature
report a mild to moderate predominance of the
female gender in PHN, similar results to those
found in our data (6) (7).
Out of the total of patients with post-herpetic
neuralgia, the majority belonged to a range of age
between 50 and 79 years of age, data which was
similar to that found in previous European studies
(8).
71% of patients that were involved in the study
did receive previous antiviral treatment, while
nevertheless, Asian literature indicates previous
use of antiviral agents represents 61% (9) (10).
All of the patients in the study received some
type of neuropathic treatment, in comparison to a
French study that reports use of pain medication in
83% of cases and a report in the United Kingdom
in which pain medication is indicated in 54% of
the cases (11) (12).
Out of the total patients, 57% presented a lapse
of time for the evolution of PHN from 13 to 24
months; similar data was found in an english report
that indicates that the majority of patients (59%)
suered PHN for a lapse of time of more than a
year, with a mean time greater than 36 months. In
this study, tingling sensation at 74% was the most
frequent symptom that accompanied postherpetic
neuralgia, a percentage that almost doubles that of
a french study where tingling sensation occupies
40% of cases and burning sensation representing
51% is the most frequent symptom. In our study,
a burning sensation presented itself in 57% of
the cases. A Spanish report about neuropathic
pain indicates the most frequent symptoms to be
tingling sensation, burning sensation, pinching
pain, electric discharge and numbing, data which
corresponds with our results except regarding
numbness (13).
As to the symptomatic burden’s relationship with
quality of life in post-herpetic neuralgia, both pain
by touch and numbing presented P values of 0.00
indicating strong statistical signicance, which is
aligned with current literature where values of P <
0.001 are reported in pain by touch and numbness.
In this paper pinching had a P Value of P 0.03, a
value that lies close to that of European literature
with a P Value of P <0.001. Symptoms such as
tingling sensation presented a P value of 0.07 and
stinging a P value of 0.08, electrical discharge
with a P value of 0.57 and burning sensation
with a P value of 0.81, presented in that order
the slightest evidence or statistical signicance.
However current literature diers in these points
as tingling sensation, stinging sensation, electrical
discharge and burning sensation all have P Values
of P < 0.001 (14).
As to the assessment of severity of PHN and
its relationship with quality of life, a dispersion
diagram with Pearson correlation coecient
was performed, using the scores of the DN4
(Neuropathic Pain Evaluation) questionnaires in
the X axis and the EQ-5D-5L (Quality of life)
in the Y axis. A cloud of points was obtained,
which turns around the line’s axis, and which
demonstrates that a mild negative correlation
exists between the scores obtained by the patient.
When performing the dispersion diagram to
value the level of severity of the PHN and its
relationship with quality of life, it is observed that
Quality of Life is indeed related with Neuropathic
Pain. The state of bibliography about assessing
the level of PHN and its relationship with Quality
of life via the Questionnaires DN4 and EQ-5D-
5L is non existent, thus, there is no information
with which to compare or correlate the Patient
Obtained results, or discuss the results obtained
in this study.
Taking as value the referential index of the EQ-
5D-5L questionnaire, which was 0.651, we can
conclude that 82% of the cases, being accompanied
or not by neuropathic pain, obtained values superior
to that of reference. This is to say they presented
a better state of health or a better quality of life.
18% of cases, accompanied by neuropathic pain,
had scores lower to the one of reference, reporting
a worse state of health or aectation of their
quality of life. The mean index value in our study
was 0.814, value that corresponds to a better state
of health in the patients; being a value superior
to that of a canadian study which indicates that
quality of life was highly correlated with gravity
of pain and in participants that informed about
clinically signicant pain, mean punctuation of
quality of life was 0,67, value which remained
constant while the neuropathic pain persisted (15).
After performing the dispersion diagram to
evaluate the level of severity of the
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Post-Herpetic neuralgia and its relationship with
quality of life, it is observed that this condition is
indeed related to neuropathic pain.
Conclusions
The gender most aected by Post-Herpetic-
Neuralgia was female. The most aected age
range was 50 to 79 years of age. Belonging to this
age group implies greater deterioration in quality
of life.
The majority diagnosed with Post-Herpetic-
Neuralgia did receive previous antiviral treatment,
due to the fact that this type of treatment provides
great benet to the patient’s state of health.
More than half of the patients presented a time of
evolution of PHN that went from 13 to 24 months.
This group was followed by the group with time
of evolution greater than 24 months of evolution.
The most important symptom that accompanied
PHN was tingling sensation, followed by other
symptomatology such as stinging pain, electric
discharge and burning sensation.
In regards to the symptomatic burden related
with quality of life in PHN, we can conclude
that symptoms like pain by touch and numbness
registered a strong statistical signicance, being
followed by pinching sensation.
The mean value of PRO DN4 was 4/10, being
this the minimum necessary to consider a result as
neuropathic pain, and the mean value index in this
investigation demonstrated a good state of health
in the participants.
After performing the dispersion diagram to
evaluate the level of severity of the post herpetic
neuralgia and its relationship with quality of life,
it was determined that quality of life is indeed
related with neuropathic pain.
Analyzing the mean referential value obtained
in the PRO EQ-5D-5L, one can reach the
conclusion that the majority of cases, with or
without neuropathic pain, presented values well
over the referential one, showcasing a very good
quality of life. Another percentage, accompanied
by neuropathic pain, presented values below the
referential one, and showed aectation of their
quality of life, which shows that quality of life
is indeed aected in patients with post-herpetic
neuropathy.
Peer review
The manuscript was peer reviewed and approved
by the INSPILIP Journal
Data Availability and Materials
Data presented in this manuscript is available
under request to the author
Financing
This study is self-nanced
Ethical Aspects
Previous to the writing of this study, informed
consent was voluntarily signed by the patients,
respecting bio-ethical norms as well as identity
protection.
Conict of interests
There are no conicts of interests, be them
personal, professional, nancial or of any other
kind.
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