Construction Of Prediction Model For Postherpetic Neuralgia Based On Different Syndromes And Study Of Early Analgesi

Background:Postherpetic neuralgia(PHN),a relatively common neuropathic pain in clinical practice,is a direct result of peripheral nerve damage during herpes zoster(HZ)infection.The prevalence rates of HZ and PHN were 7.7%and 2.3%in China,respectively,and the prevalence of PHN in HZ was 29.8%.PHN is the most long-lasting and serious complication of HZ,manifesting as persistent or intermittent pain of multiple painful properties such as burning pain,throbbing pain,and stabbing pain at the same time.And this severe pain can have a tremendous negative impact on the patient’s quality of life and ability to perform daily activities.Severe PHN can cause adverse symptoms such as sleep disturbance,fatigue,and depression in patients,reduce their quality of life and adversely affect families and society.At present,the clinical efficacy of various treatment methods for PHN is often unsatisfactory,and more than 50%of PHN patients have not seen significant relief of symptoms after treatment.Therefore,early prevention is necessary for people at high risk of PHN.And to provide targeted treatment for high-risk groups,it is necessary to first identify the type of patients who are prone to PHN,that is,to find the risk factors affecting the development of PHN.Secondly,an effective treatment is needed to prevent the development of PHN or to reduce the symptoms of PHN when it occurs.Clinical prediction models are an important tool for finding risk factors,a nomogram can visualize risk factors.Spinal cord stimulation(SCS)is a well-recognized,safe,effective,and reversible technique to relieve symptoms and improve function and overall quality of life in patients with chronic neuropathic pain.Short term spinal cord stimulation(stSCS)is derived from SCS.It is externally connected to a pulse generator without implantation in the body.The treatment cycle is generally 7-14 days,making the treatment more minimally invasive and convenient.Objective:Through the combination of traditional Chinese and Western medicine,the risk factors affecting the occurrence of PHN were searched and a clinical prediction model was developed,which was visualized using a nomogram,and the predictive efficacy of the model was tested.Patients with herpes zoster neuralgia(HZN)were classified into different syndrome types through TCM syndrome identification,and all patients were treated with st-SCS to observe its effectiveness,its preventive effect on the occurrence of PHN,and to analyze the relationship between different TCM syndrome types and the efficacy.Methods:This study is divided into three parts.(1)In study 1,a combination of subject headings and free words was used to search the commonly used Chinese and English databases,and strict inclusion and exclusion criteria were formulated.Two independent researchers screened the literature and extracted and organized data.Through the Meta analysis of the previous literature,the risk factors affecting the incidence of PHN were preliminarily obtained.(2)In study 2,the prospective cohort study was conducted,and the possible risk factors for PHN were first screened according to univariate analysis,and the results of the univariate analysis were analyzed using multivariate logistic regression analysis was used to remove confounding factors and obtain independent risk factors affecting the occurrence of PHN.Then use R 4.0.5 software to build a suitable clinical prediction model and draw a nomogram to predict the incidence of PHN.The accuracy of the model was verified by analyzing the calibration curve of the prediction model and the number of the reference C index.The receiver operating characteristic(ROC)curve was plotted to reflect the sensitivity and specificity of the model,and the area under the ROC curve was also calculated to judge the prediction accuracy.The clinical decision analysis(DCA)curve was plotted to judge the model by the net benefit rate in the PHN disease group under different probabilities clinical validity.(3)Study 3 divided the included HZN patients into "Qi deficiency and blood stasis group" and "Qi stagnation and blood stasis group" by Chinese medicine identification.Patients in both groups were treated with st-SCS and scored on other TCM symptoms,VAS,SF-MPQ and HAMA before,1 day after,1 week after,1 month after,and 3 months after surgery,respectively,and PSQI score for both groups at preoperative,1 month postoperative and 3 months postoperative.And the effect of st-SCS on TCM syndromes,pain,mood,sleep,and the prevention of PHN occurrence in patients with different types of herpes zoster neuralgia were observed.The curative effect of the patients was judged 3 months after the operation,and the relationship between TCM syndrome types and the curative effect of st-SCS was explored by comparing the curative effects of st-SCS on HZN patients with different syndromes.Results:(1)Study 1 included 13 cohort studies and case-control studies.Meta analysis results showed that the risk factors affecting the occurrence of PHN were:age>50 years(2.13,1.12～4.04),high VAS score in the acute stage(4.11,1.69～10),initial treatment time>3 days(5.84,2.84～12.02),combined with underlying diseases(6.11,2.87～13.01),combined with diabetes(3.65,1.33～9.98).(2)Study 2 included 191 HZ patients.According to multivariate logistic regression analysis,the risk factors of PHN were screened out:age≥50 years old(4.15,1.59～10.83),spleen deficiency and dampness accumulation syndrome(0.74,1.02～4.26),initial treatment time>3 days(0.96,1.08～6.32),VAS score in the acute stage(1.02,1.01～1.04),skin lesion area>3%(2.62,1.01～6.78).The accuracy of the test model showed that the C index was 0.78,and its 95%confidence interval was 0.71-0.86.The calibration curve coincides well with the actual curve,the area under the ROC curve is 0.78,and the DCA curve analysis showed the highest accuracy and net benefit of clinical application of the model when the patient had a disease probability between 5%and 85%.(3)Study 3 included 32 HZN patients,16 patients in qi deficiency and blood stasis group and 16 patients in qi stagnation and blood stasis group.The results showed that the VAS,SF-MPQ,HAMA and PSQI score of the two groups at 1 day,1 week,1 month and 3 months after the surgery were significantly lower than those before the surgery,the difference was statistically significant(P<0.05).The scores of other TCM symptoms were lower in both groups at 1 day,1 week,1 month and 3 months after surgery than before surgery,and the difference was statistically significant in the patients with Qi deficiency and blood stasis(P<0.05).Three months after the surgery,there was a statistically significant difference in the VAS score between the two groups(P<0.05).The clinical effective rate showed that the Qi deficiency and blood stasis group was 81.25%,and the Qi stagnation and blood stasis group was 43.75%,and the difference was statistically significant(P<0.05).Conclusions:(1)Meta analysis found that age≥ 50 years old,high VAS score in acute stage,initial treatment time>3 d,combined with underlying diseases,and combined with diabetes were the risk factors for the occurrence of PHN.(2)A total of 5 risk factors affecting the occurrence of PHN were found through prospective cohort studies,namely,high VAS score in the acute phase,age≥50 years old,skin lesion area>3%,initial treatment time≥ 3 days,and TCM syndrome differentiation as spleen deficiency and dampness accumulation syndrome.The nomogram of the clinical prediction model was established through R software.The accuracy of the model developed in this study was demonstrated by the C index of 0.78,the area under the ROC curve of 0.78 and the good overlap between the model calibration curve and the actual curve;the DCA curve showed that the accuracy and net benefit of the clinical use of this model were highest when the probability of PHN occurred between 5%and 85%.(3)St-SCS can relieve pain symptoms of HZN patients with different TCM syndrome types,improve patient’s anxiety,improve patient’s sleep quality,and significantly reduce the symptoms of PHN onset.St-SCS can regulate the Du meridian,and achieve the effect of nourishing righteousness,promoting blood circulation and removing blood stasis.St-SCS can reduce patient’s TCM symptoms scores and provide better pain relief in patients with Qi deficiency and blood stasis.