Herpes zoster (HZ) is viral infection that occurs with reactivation of the varicella zoster virus.1,2 Although symptoms of HZ typically resolve within 2 to 4 weeks, 5%–20% of those with HZ go on to develop postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the onset of the rash in the same affected area.1,2 Both frequency and severity of PHN increase with advancing age and pain can persist for months to years after resolution of the rash.2
Zhu and colleagues sought to examine the role of Mindfulness Based Stress Reduction (MBSR) in PHN treatment in a trial comparing MBSR with routine care.3 Fifty patients, 50 years old or older, suffering 3 to 7 months of neuralgia post HZ treatment were randomized to either MBSR or a usual care control group. Participants were assessed on depression, anxiety and pain.
Post MBSR program, the mean pain intensity on the Numeric Pain Rating Scale was significantly decreased in the MBSR group (before 9.01 + 4.56, after 6.53 + 3.57), whereas no significant change was observed for the control group (before 9.32 + 5.03, after 9.41 + 4.32). On this scale, 0 represents no pain; 1 to 3 is mild pain; 4 to 6 represents moderate pain; and 7 to 10 is severe pain.
Post MBSR program, the mean depression level on the Hamilton Depression Rating Scale was significantly decreased in the MBSR group (before 21.01 + 3.52, after 17.26 + 3.23), whereas no significant change was observed for the control group (before 20.91 + 3.06, after 19.46 + 2.53). If the total score on this measure is higher than 18, the patient is considered depressed.
Post MBSR program, the mean anxiety level on the Hamilton Anxiety Rating Scale was significantly decreased in the MBSR group (before 21.21 + 3.48, after 16.34 + 3.56), whereas no significant change was observed for the control group (before 21.02 + 3.43, after 19.58 + 3.41). On this measure, 0 indicates absence of anxiety; 1 to 17, mild anxiety; 18 to 24, moderate anxiety; and 25 to 56, severe or intense anxiety.
This initial study shows promise for the role of MBSR in the care of patients with PHN. Although further research with larger sample sizes, a comparison active intervention and long-term follow up is needed, this preliminary evidence suggests that mindfulness training may improve the quality of life in patients with HPN by reducing of both pain and psychological distress.
1Hadley GR, Gayle JA, Ripoll J, et al. Post-herpetic neuralgia: a review. Curr Pain Headache Rep. 2016;20(3):17.
2Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc. 2016;9:447-454.
3Zhu X, Hu P, Fan Z, et al. Effects of Mindfulness-Based Stress Reduction on depression, anxiety, and pain in patients with postherpetic neuralgia. J Nerv Ment Dis. 2019;207(6):482-486.