带状疱疹疼痛患者远期疼痛危险因素分析

目的 探讨带状疱疹(HZ)急性期疼痛患者发生远期(>6个月)疼痛的危险因素。方法 采用1:1配对的病例对照研究方法,纳入6个月后VAS评分≥3分的带状疱疹神经痛患者102例为病例组,与其年龄、性别、受累神经节段相匹配且未发生远期疼痛的患者102例为对照组,对影响因素行单因素和多因素条件Logistic回归分析。结果 前驱痛(OR=4.26,95%CI:2.09～8.69)、糖尿病(OR=4.06,95%CI:1.62～10.07)、72 h内使用抗病毒药物(OR=0.26,95%CI:0.12～0.55)、使用钙通道调节剂(OR=0.35,95%CI:0.17～0.75)、阿片类药物使用<4周(OR=0.29,95%CI:0.11～0.74)、阿片类药物使用≥4周(OR=1.87,95%CI:0.79～4.45)、72 h内就医(OR=0.61,95%CI:0.28～1.33)与带状疱疹急性期疼痛患者发生远期疼痛存在相关性。结论 前驱痛、糖尿病是HZ急性期疼痛患者发生远期疼痛的危险因素;72 h内使用抗病毒药物、使用钙通道调节剂、阿片类药物使用<4周是HZ急性期疼痛患...     

PRF治疗带状疱疹后神经痛疗效的影响因素分析

目的 筛选脉冲射频术(PRF)治疗带状疱疹后神经痛疗效的影响因素。方法 纳入303例PRF治疗的带状疱疹后神经痛患者,使用数字评价量表(NRS)评价疼痛。PRF后3个月NRS评分较术前下降>50%视为治疗有效,并分为有效组和无效组。对组间差异比较有统计学意义的变量进行Logistic回归分析,筛选影响因素。结果 PRF治疗带状疱疹后神经痛术后3个月有效率为73.3%,糖尿病(OR=2.179,95%CI=1.052～4.514)、病程(OR=1.823,95%CI=1.556～2.137)、射频电压(OR=0.435,95%CI=0.217～0.872)、射频神经(OR=0.421,95%CI=0.209～0.849)与PRF治疗带状疱疹后神经痛的疗效存在相关性。结论 糖尿病和病程是PRF治疗带状疱疹后神经痛疗效的独立危险因素;高射频电压、3个射频神经为PRF疗效的有利因素。     

带状疱疹后遗神经痛的研究进展

<正>带状疱疹后遗神经痛(PHN)是带状疱疹最常见的并发症,好发于老年人,因疼痛剧烈,持续时间长,严重影响人们正常工作和生活,而带状疱疹经抗病毒及相应治疗可较快消退,故本文将着重介绍近年来带状疱疹后遗神经痛的病因、发病机制及病理研究进展。     

中医清热利湿法辅助治疗急性带状疱疹30例分析

带状疱疹是由水痘-带状疱疹病毒感染引起的急性疱疹性皮肤疾病,以沿周围神经分布的群集疱疹及神经痛为特征。目前,西医治疗该疾病主要原则为抗病毒、消炎止痛、营养神经等,其中抗病毒治疗是其中的关键环节,能阻断病毒对神经的损伤,在控制皮损和疼痛的症状以及预防后遗神经痛(postherpetic neuralgia,PHN)有一定的疗效[1],但PHN发生率仍达50%~85%[2],严重影响患者生活     

带状疱疹后遗神经痛相关因素的分析及护理

目的研究影响带状疱疹后遗神经痛疼痛(postherpetic neuralgia,PHN)程度的相关因素,提出相应的护理对策。方法对82例带状疱疹后遗神经痛患者进行视觉模拟评分(visual analog scale,VAS)评估,并记录患者的年龄、性别、PHN急性期疼痛的发作频率、疼痛的性质、疱疹部位,分析这些因素与经痛程度的相关性,提出相应的护理对策。结果PHN疼痛程度与性别显著相关(P<0.05),而与年龄、疼痛发作频率、疼痛的性质、疱疹部位无显著相关。患者急性期发作频度以持续性疼痛(78.0%)居多,疼痛性质以烧灼样(39.0%)和针刺样(28.0%)为主。结论对PHN患者应重视疼痛的护理评估和健康教育,尤其是对老年男性持续性烧灼样和针刺样疼痛的患者,应积极实施心理护理;教会患者缓解疼痛的方式,以减轻疼痛提高患者的生活质量。     

基于结构方程模型的带状疱疹后神经痛影响因素分析

目的：基于结构方程模型探讨带状疱疹后神经痛(postherpetic neuralgia, PHN)各影响因素之间的关系。方法：收集2012年1月至2022年12月于华中科技大学协和深圳医院住院的带状疱疹(herpes zoster, HZ)及PHN资料完整的病例627例，按照有无PHN分为PHN组和非PHN组，采用单因素和Logistic回归分析筛选发生PHN的危险因素，并基于结构方程模型分析PHN各因素间的关系。结果：共纳入627例病人，按PHN发生情况分为PHN组（156例）和非PHN组（471例）。Logistic回归分析筛选出性别、年龄、皮疹面积、急性期疼痛评分、感觉异常、糖尿病、癌症共6个危险因素。结构方程模型显示，性别、年龄、皮疹面积、急性期疼痛评分、感觉异常、糖尿病、癌症均对PHN有直接效应，其路径系数分别为0.124、0.198、0.116、0.075、0.234、0.082、0.085；年龄、糖尿病对PHN具有直接与间接影响，其总路径系数分别为0.238、0.128。结论：PHN受性别、年龄、皮疹面积、急性期疼痛评分、感觉异常、糖尿病、癌症因素的影响，年龄、糖尿病对...     

脉冲射频治疗三叉神经带状疱疹后神经痛的疗效观察

带状疱疹后遗神经痛(postherpetic neuralgia, PHN)表现为持续性疼痛(几个月甚至几年),临床上一般疱疹消失后,相应的感觉神经支配区仍然遗留或重新出现疼痛.三叉神经区疱疹后遗神经痛由于解剖位置特殊加上发病初期治疗的不到位或不规范,可遗留顽固性疼痛.PHN保守治疗疗效差,而手术治疗风险大,患者不愿意接受.本科用脉冲射频治疗三叉神经PHN,取得了良好的临床效果.     

短时程脊髓电刺激对不同病程带状疱疹性神经痛的疗效分析

目的:观察短时程脊髓电刺激(temporary spinal cCord sStimulation, tSCS)对不同病程带状疱疹性神经痛(zoster-related neuralgia, ZRN)的长期疗效。方法:本文采用回顾性分析纳入99例ZRN病人,包括42例急性疱疹性神经痛(acute herpetic neuralgia, AHN)病人,34例亚急性疱疹性神经痛(subacute herpetic neuralgia, SHN)病人以及23例疱疹后神经痛(postherpetic neuralgia, PHN)病人在保守治疗无效后接受1～2周t SCS治疗,对术前及术后1、3、6和12月等各时间段病人的疼痛程度、睡眠质量、镇痛药物使用情况进行汇总分析。结果:所有病人在t SCS治疗后VAS和PSQI均有明显下降(P <0.001)。然而AHN组和SHN组的两项评分比PHN组下降得更明显(P<0.001)。其中AHN组下降最明显。SHN和PHN组的VAS和PSQI在术后1个月有评分反弹现象。t SCS治疗后三组病人的镇痛药物使用人数均下降。AHN组的下降趋势最明显,随访3、6及12个月后AHN组中仍遗留疼痛的人数比例最少。本研究中未见严重不良反应。结论:tSCS是一种治疗早期顽固性ZRN非常安全有效的微创技术。与PHN相比,tSCS治疗AHN和SHN时效果更佳。     

特殊类型呼吸道异物取出术的围手术期护理

目的 研究影响带状疱疹后遗神经痛疼痛（postherpetic neuralgia，PHN）程度的相关因素。提出相应的护理对策。方法 对82例带状疱疹后遗神经痛患者进行视觉模拟评分（visual analog scale,VAS）评估，并记录患者的年龄、性别、PHN急性期疼痛的发作频率、疼痛的性质、疱疹部位，分析这些因素与经痛程度的相关性，提出相应的护理对策。结果 PHN疼痛程度与性别显著相关（P〈0．05），而与年龄、疼痛发作频率、疼痛的性质、疱疹部位无显著相关。患者急性期发作频度以持续性疼痛（78．0％）居多，疼痛性质以烧灼样（39．0％）和针刺样（28．0％）为主。结论 对PHN患者应重视疼痛的护理评估和健康教育，尤其是对老年男性持续性烧灼样和针刺样疼痛的患者，应积极实施心理护理；教会患者缓解疼痛的方式，以减轻疼痛提高患者的生活质量。     

神经阻滞疗法治疗带状疱疹后神经痛的研究进展

带状疱疹后神经痛(postherpetic neuralgia,PHN)是带状疱疹最常见的并发症,以顽固性慢性疼痛为特征。PHN在老年人及免疫力低下者多发,年龄是PHN的风险因素。PHN严重影响病人的日常工作和生活。因其发病机制目前不十分明确,故临床治疗困难,目前很多可供选择的治疗方法均为缓解病人的疼痛症状。其中神经阻滞疗法对于治疗PHN具有独特的疗效和优势,值得临床普遍应用和推广。本文就神经阻滞治疗带状疱疹后神经痛的方法进行归纳,旨在为临床工作提供参考。     

Predicting postherpetic neuralgia in elderly primary care patients with herpes zoster: prospective prognostic study

Postherpetic neuralgia (PHN) is the most frequent complication of herpes zoster (HZ) and difficult to treat. Timely identification of high-risk HZ-patients enables physicians to focus on PHN prevention. To assess which simple to measure factors are independent predictors of PHN, and whether psychosocial and serological/virological parameters have additional predictive value, a prospective cohort study in primary care was conducted. We included 598 elderly (>50 years) consecutive patients with acute HZ (rash <7 days) below sixth cervical dermatome. At baseline demographic, clinical (e.g., duration and severity of pain and rash), psychological (Pain Cognition List [PCL] and Spielberger's Anxiety Inventory), serological (VZV-antibodies) and virological (viremia presence) variables were measured. Blood tests were performed in a random subset of 218 patients. Primary outcome was significant pain (VAS >30 on 0-100 scale) after three months. The final prediction model obtained from multivariable logistic regression was (internally) validated using bootstrapping techniques, and adjusted for optimism. Forty-six (7.7%) patients developed PHN. Independent predictors were age (odds ratio [OR]=1.08 per year), acute pain severity (OR=1.02 per unit), presence of severe rash (OR=2.31), and rash duration before consultation (OR=0.78 per day): area under receiver-operating-characteristic curve [ROC area]=0.77 (95% CI: 0.71-0.82). Of the five PCL scores, only factor V ('trust in healthcare') was an additional predictor (OR=1.01 per unit), though it increased the ROC area with only 0.01 to 0.78. The Spielberger's anxiety scores and serological and virological variables were no additional predictors. Thus, four simple variables can help physicians to timely identify elderly HZ-patients at risk of PHN.     

Predictors of Postherpetic Neuralgia Among Patients With Herpes Zoster: A Prospective Study

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The main objectives of this study were to: 1) estimate the severity and duration of PHN; and 2) identify the predictors of PHN. From October, 2005 to July, 2006, 261 outpatients with HZ, aged ≥50, were recruited within 14 days of rash onset during the routine clinical practice of 83 physicians across Canada. Physicians documented HZ characteristics, treatments, general health, functional, and immune status. HZ pain was measured at recruitment and on days 7, 14, 21, 30, 60, 90, 120, 150, and 180 following recruitment. PHN was defined as a worst pain ≥3 persisting or appearing more than 90 days after rash onset. Predictors of PHN were obtained by hierarchical log-binomial regression. Twenty-two percent of 249 immunocompetent subjects with HZ developed PHN. Median duration of PHN was 77 days. Independent predictors of PHN included: older age, limitation in performing usual activities prior to HZ, and pain severity at recruitment. This study confirms that older age and greater acute pain severity are predictors of PHN, while functional status emerges as a novel independent predictor of PHN that deserves further exploration. These findings will contribute to optimal use of the HZ vaccine and testing of new therapies that might prevent PHN.     

Postherpetic Neuralgia: The Never-Ending Challenge

Abstract: Postherpetic neuralgia (PHN) is defined as pain that persists 1 to 3 months following the rash of herpes zoster (HZ). PHN affects about 50% of patients over 60 years of age and 15% of all HZ patients. Patients with PHN may experience two types of pain: a steady, aching, boring pain and a paroxysmal lancinating pain, usually exacerbated by contact with the involved skin. Herpes zoster is initially a clinical diagnosis, based on the observation of a typical dermatomal distribution of rash and radicular pain. HZ is pathologically characterized by inflammatory necrosis of dorsal root ganglia, occasionally associated with evidence of neuritis, leptomeningitis, and segmental unilateral degeneration of related motor and sensory roots. Although acyclovir has been used successfully as standard therapy for varicella zoster virus (VZV) infection in the past decade, resistant strains of VZV are often recognized in immunocompromised patients. Therapy with acyclovir and the use of corticosteroids have been reported to prevent PHN in up to 60% of HZ patients. Management of chronic pain in PHN is more problematic. The only therapy proven effective for PHN in controlled study is the use of tricyclic antidepressants, including amitriptyline and desipramine. There is good evidence of efficacy from randomized trials that gabapentin and pregabalin (new anticonvulsant drugs) are of benefit in the reduction of pain from PHN. As alternative therapies, topical agents such as capsaicin, lidocaine or opioid analgesic treatment may give satisfactory results. Interventions with low risk, such as transcutaneous electrical nerve stimulation (TENS), are appropriate. Evidence is scant for the value of surgical and procedural interventions in general, although there are numerous, small studies supporting the use of specific interventions such as nerve blocks, neurosurgical procedures, and neuroaugmentation. Although antiviral agents are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN. Postherpetic neuralgia remains a difficult pain problem. This review describes the epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain generation with emphasis on the various pharmacological treatments and invasive modalities currently available.     

The lifetime occurrence of Herpes zoster and prevalence of post-herpetic neuralgia: A retrospective survey in an elderly population

One-thousand-and-seventy-one randomly chosen elderly persons (537 women, 534 men; median age 80) were recruited from the Institute of Human Aging (Dept of Psychiatry, University of Liverpool). Almost a quarter (23.8%; equal numbers of both sexes) had had shingles (HZ), at a median age of 60 (for both sexes); 39 subjects (3.6% of all respondents, 15% of those who had had shingles), two thirds of whom were female, developed post-herpetic neuralgia (PHN), defined as pain persisting for more than 3 months; they acquired HZ at a median age of 70. In 22 of them, pain had resolved by the time they were questioned, but in 17 it was ongoing (from less than 12 to 504 months). Two new independent risk factors for PHN were identified: (1) female gender; and (2) living alone at the time of HZ acquisition (p = 0.009). In addition to confirming the well-known factor of: (3) age at shingles acquisition (up to the early 90s); and (4) scarring, presumed to be a consequence of rash severity, was significantly commoner in subjects whose HZ was followed by PHN.Extrapolating the prevalence figures to the whole UK population, of whom 9.28 million were over 64 in 1992, it can be conservatively estimated that at any one time, some 200 000 people in the UK have PHN.     

Treatment of herpes zoster

OBJECTIVE

To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).

QUALITY OF EVIDENCE

The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).

MAIN MESSAGE

Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.

CONCLUSION

Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.     

Factors influencing the features of postherpetic neuralgia and outcome when treated with tricyclics.

This paper retrospectively reviews features of postherpetic neuralgia (PHN) in up to 279 personal patients in relation to treatment outcome when treated with tricyclic antidepressants (TCAs). Factors affecting characteristics of PHN: (i) Patients with allodynia (89%) and/or burning pain (56%) have a much higher visual analogue pain intensity score than those without; (ii) Acyclovir (ACV) given for acute shingles (HZ) does not reduce the incidence of subsequent PHN, but reduces the pain intensity in PHN patients with allodynia; (iii) ACV given for acute HZ reduces the incidence of burning pain in subsequent PHN, but not of allodynia; (iv) ACV given for acute HZ reduces the incidence of clinically detectable sensory deficit in subsequent PHN. Factors affecting outcome of TCA-treated PHN: (i) The point in time at which TCA treatment is commenced is by far the most critical factor: started between 3 and 12 months after acute HZ onset, more than two-thirds obtain pain relief (NNT=1.8); between 13 and 24 months, two-fifths (41%) (NNT=3.6); and more than two years, one-third (NNT=8.3). Background and paroxysmal pain disappear earlier and are more susceptible of relief than allodynia. (ii) Twice as many (86%) of PHN patients without allodynia obtain pain relief with TCA treatment than those with (42%); (iii) the use of ACV for acute HZ more than halves the time-to-relief of PHN patients by TCAs; (iv) PHN patients with burning pain are significantly less likely to obtain pain relief with TCAs than those without (p<0.0001).     

Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy

OBJECTIVE: This article reviews the prevalence, risk factors, natural history, and impact on quality of life of painful diabetic neuropathy (PDN) and postherpetic neuralgia (PHN). DISCUSSION: Diabetes mellitus afflicts more than 14 million persons in the U.S. An estimated 20% to 24% of these persons experience PDN. Data on risk factors for PDN are limited, but duration of diabetes mellitus and poor glycemic control are probably important factors. Painful diabetic neuropathy may interfere with general activity, mood, mobility, work, social relations, sleep, leisure activities, and enjoyment of life. Herpes zoster strikes an estimated 800,000 persons each year in the U.S., most of whom are elderly or immunosuppressed. Using pain at 3 months after rash onset as a definition of PHN, between 25% and 50% of adults older than 50 years develop PHN, depending on early antiviral therapy for herpes zoster. Increasing age, greater pain and rash severity, greater degree of sensory impairment, and psychological distress are risk factors for PHN. Postherpetic neuralgia may cause fatigue, insomnia, depression, anxiety, interference with social roles and leisure activity, and impaired basic and instrumental activities of daily living. CONCLUSIONS: Both conditions are common complications of their underlying disorders and can profoundly diminish the quality of life of affected persons.     

Complex regional pain syndrome-like symptoms during herpes zoster

Complex Regional Pain Syndrome (CRPS) associated with herpes zoster (HZ) was first reported by Sudeck in 1901 (Sudeck, 1901) and is recognized clinically. However, only 13 cases have been published in the literature, and nothing is known about the incidence, prevalence, or natural history (Chester, 1992; Foster et al., 1989; Grosslight et al., 1986; Ketz and Schliack,1968; Kishimoto et al., 1995; Querol and Cisneros, 2001; Sudeck, 1901; Visitsunthorn and Prete, 1981). The aim of the present study was to determine the prevalence of CRPS-like symptoms in a prospectively gathered cohort of subjects with HZ and to follow the natural history of their pain and sensory disturbance during the first 6 months after onset of HZ. Subjects were evaluated at four time points after HZ: 2-6 weeks, 6-8 weeks, 3 months, and 6 months. Only subjects aged 50 or older with pain VAS ratings of >/=20/100 at 2-6 weeks were eligible. The first (screening) visit included a neurological and physical examination that was updated at each subsequent visit. Assessments included ratings of pain intensity, allodynia severity, and rash severity. The neurological exam included determination of presence or absence of the following CRPS-like symptoms: (1) increased sweating, (2) color changes, (3) skin temperature changes, (4) weakness of the affected area based on physical exam, (5) edema, and (6) extension of CRPS-like symptoms outside the affected dermatome. For subjects with HZ in dermatomes that can include the limbs (C4-T2 and L1-S2), extremity involvement was considered present if allodynia or rash extended beyond the neck of the humerus (upper extremity), the inguinal ligament (anterior lower extremity), or gluteal sulcus (posterior lower extremity). Involvement of the extremity was considered proximal if neither HZ rash nor allodynia extended past the elbow (upper extremity) or knee (lower extremity). Of the first 75 subjects recruited, 25 had HZ outbreaks in dermatomes that extended into the extremities (C4-T2 and L1-S2). In this group, 8 subjects had no extremity involvement, 8 had proximal extremity involvement, and 9 had distal extremity involvement. Subjects with distal extremity HZ reported more pain across the four visits (p < 0.05). At 3 months, more subjects with distal extremity involvement met criteria for PHN (8 out of 9, 89%), while only 4 out of 8 (50%) with proximal involvement and 2 out of 8 (25%) of subjects without extremity involvement met criteria for PHN (Chi-square test: p < 0.05). Only 25 out of the remaining 50 (50%) subjects with outbreaks in dermatomes that do not include the extremities met criteria for PHN at 3 months (Chi-square test: p < 0.05). Six months after onset of HZ, 6 out of 9 subjects with distal extremity involvement met PHN criteria compared with 2 out of 8 (25%) with proximal involvement and 2 out of 8 (25%) without extremity involvement (Chi-square test: p = 0.12). Fifteen out of 50 (30%) subjects with outbreaks in dermatomes that do not include the extremities met criteria for PHN (Chi-square test: p < 0.05). No subject had all six CRPS-like symptoms. Of the 17 subjects with extremity involvement, 9 subjects had '0-2 CRPS-like symptoms' and 8 had '3-5 CRPS-like symptoms'. None of the eight subjects without extremity involvement had any CRPS-like symptoms. Of the 50 subjects with HZ outside the extremity, only one had abdominal weakness. Pain ratings were higher in subjects with '3-5 CRPS-like symptoms'. More subjects with '3-5 CRPS-like symptoms' met criteria for PHN at 3 months (7 out of 8, 88%), compared to 5 out of 9 (55%) of subjects with '0-2 CRPS-like symptoms' (p = 0.07). At 6 months, 2 out of 9 (22%) of subjects with '0-2 CRPS-like symptoms' met criteria for PHN, compared with 6 out of 8 (75%) of subjects with '3-5 CRPS-like symptoms' (Chi-square test: p < 0.03). Two case-reports are presented. In summary, the occurrence of CRPS-like symptoms is common in subjects with HZ outbreaks affecting the extremity, particularly if the distal extremity is involved. It is uncertain if the pathophysiology underlying the CRPS-like symptoms observed in this study is similar to that of CRPS from other causes, or if it is relatively specific to HZ. Development of PHN is common in subjects who have experienced CRPS-like symptoms. More aggressive preventive treatments may be justified in this high-risk subset of HZ subjects to prevent development of PHN. Prospective randomized controlled studies are needed to determine which subjects are most likely to benefit and when treatment should begin.     

Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory.

In preparation for clinical trials of a vaccine against herpes zoster (HZ), we conducted a prospective, observational study to evaluate (1) the Zoster Brief Pain Inventory (ZBPI), an HZ-specific questionnaire to quantify HZ pain and discomfort, (2) an operational definition of postherpetic neuralgia (PHN), and (3) a severity-duration measure of the burden of illness caused by HZ. HZ patients aged 60 years or older (n = 121) were enrolled within 14 days of rash onset and completed ZBPI, McGill Pain Questionnaire Present Pain Intensity (PPI), quality of life (QoL), and activities of daily living (ADL) questionnaires on a predetermined schedule. Reliability, measured by intraclass correlation coefficients within 14 days of rash onset, ranged between 0.63 and 0.78. ZBPI pain scores were strongly correlated with other pain measures, interference with ADL, and worsening QoL. The operational definition of PHN, a ZBPI pain score of 3 or greater occurring 90 or more days after rash onset, had high agreement with pain worse than mild on the PPI (kappa = 0.72). The ZBPI pain severity-duration measure had high correlations with severity-duration measures of ADL interference, worsening QoL, and other pain scales. These findings support the validity and utility of the ZBPI, the definition of PHN, and the severity-duration measure of the burden of HZ illness. PERSPECTIVE: Herpes zoster pain, as measured by the ZBPI severity-duration measure, is associated with impairment in daily living activities and quality of life. The ZBPI measure appears useful for quantifying herpes zoster pain, postherpetic neuralgia, and impairment in daily living activities for clinical trials of herpes zoster prevention.