The role of Vitamin D deficiency in neuropathic pain following Herpes Zoster: a retrospective cohort study

Abstract

significantly impacts quality of life. In this context, the objective of this study is to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and the severity, duration, and neuropathic symptoms of PHN. Material and Methods: The sample of this retrospective observational cohort study consisted of 71 patients who were followed up with a diagnosis of PHN between January 2020 and June 2024. Patients were stratified into three groups according to their serum 25(OH)D levels as patients with vitamin D deficiency (≤20 ng/mL, n=24), vitamin D insufficiency (21-29 ng/mL, n=26), and vitamin D sufficiency (≥30 ng/mL, n=21). Patients’ neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire and the Numeric rating scale (NRS). Inflammatory parameters such as C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and leukocyte count were recorded for each patient, and the diagnostic performance of their serum 25(OH)D levels was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The mean DN4 and NRS scores and pain duration of the patients with vitamin D deficiency were significantly higher than those of other patients (5.83±1.76 vs. 1.71±0.96, p<0.001; 8.92±1.59 vs. 6.29±2.43, p=0.001; 93.54±41.23 vs. 31.86±35.80 days, p<0.001; respectively). Serum 25(OH)D level was strongly correlated with DN4 score (r=-0.758; p<0.001), pain duration (r=-0.640; p<0.001) and NRS score (r=-0.497; p<0.001) in the negative direction. Pins-and-needles sensation and brush-evoked pain were significantly more common in patients with vitamin D deficiency than in other patients (p<0.001). Mean CRP and ESR values of patients with vitamin D deficiency were significantly higher than those of other patients (11.99±14.56 vs. 6.99±12.38 mg/L, p=0.046 and 25.71±16.58 vs. 13.75±7.01 mm/hour, p=0.007; respectively). ROC analyses revealed that the optimal serum 25(OH)D cut-off levels to predict patients with a DN4 score ≥4 and pins-and-needles sensation were 21.15 ng/mL (area under the curve [AUC]=0.862) and 25.85 ng/mL (AUC=0.930), respectively. Conclusion: Low serum vitamin D levels were associated with increased neuropathic pain intensity, prolonged pain duration, and increased inflammatory response in patients with PHN. In conclusion, vitamin D level may be a valuable biomarker for predicting the clinical course of PHN and determining appropriate treatment strategies.

Keywords

• postherpetic neuralgia
• vitamin D deficiency
• DN4 score
• neuropathic pain
• herpes zoster

Project Number

02.07.2024 tarih ve 12 sayılı

Ethical Statement

The study was approved by Pamukkale University Non-Interventional Clinical Research Ethics Committee (Date: 02.07.2024, Decision No: E-60116787-020-548385).

Herpes Zoster Sonrası Nöropatik Ağrıda D Vitamini Eksikliğinin Rolü: Retrospektif Kohort Çalışması

Abstract

Amaç: Postherpetik nevralji (PHN), herpes zoster enfeksiyonunun yaşam kalitesini önemli ölçüde etkileyen en yaygın komplikasyonudur. Bu bağlamda, bu çalışmanın amacı serum 25-hidroksivitamin D [25(OH)D] düzeyleri ile PHN'nin şiddeti, süresi ve nöropatik semptomları arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntemler: Bu retrospektif gözlemsel kohort çalışmasının örneklemi, Ocak 2020 ile Haziran 2024 arasında PHN tanısı ile takip edilen 71 hastadan oluşmaktadır. Hastalar serum 25(OH)D düzeylerine göre D vitamini eksikliği (≤20 ng/mL, n=24), D vitamini yetersizliği (21-29 ng/mL, n=26) ve D vitamini yeterliliği (≥30 ng/mL, n=21) olan hastalar olarak üç gruba ayrılmıştır. Hastaların nöropatik ağrıları nöropatik ağrı 4 (DN4) anketi ve Numerik derecelendirme ölçeği (NRS) kullanılarak değerlendirilmiştir. Her hasta için C-reaktif protein (CRP) düzeyi, eritrosit sedimentasyon hızı (ESR) ve lökosit sayısı gibi inflamatuar parametreler kaydedilmiş ve serum 25(OH)D düzeylerinin tanısal performansı alıcı işletim karakteristiği (ROC) eğrisi analizi ile değerlendirilmiştir. Bulgular: D vitamini eksikliği olan hastaların ortalama DN4 ve NRS skorları ile ağrı süreleri diğer hastalara göre anlamlı derecede yüksekti (5,83±1,76'ya karşı 1,71±0,96, p<0,001; 8,92±1,59'a karşı 6,29±2,43, p=0,001; 93,54±41,23'e karşı 31,86±35,80 gün, p<0,001; sırasıyla). Serum 25(OH)D düzeyi, DN4 skoru (r=-0,758; p<0,001), ağrı süresi (r=-0,640; p<0,001) ve NRS skoru (r=-0,497; p<0,001) ile negatif yönde güçlü korelasyon gösterdi. İğnelenme hissi ve fırçayla uyarılan ağrı, D vitamini eksikliği olan hastalarda diğer hastalara göre anlamlı derecede daha yaygındı (p<0,001). D vitamini eksikliği olan hastaların ortalama CRP ve ESR değerleri diğer hastalara göre anlamlı derecede yüksekti (11,99±14,56'ya karşı 6,99±12,38 mg/L, p=0,046 ve 25,71±16,58'e karşı 13,75±7,01 mm/saat, p=0,007; sırasıyla). ROC analizleri, DN4 skoru ≥4 olan hastaları ve iğnelenme hissini tahmin etmek için optimal serum 25(OH)D kesme düzeylerinin sırasıyla 21,15 ng/mL (eğri altında kalan alan [AUC]=0,862) ve 25,85 ng/mL (AUC=0,930) olduğunu ortaya koydu. Sonuç: Düşük serum D vitamini düzeyleri PHN hastalarında artmış nöropatik ağrı yoğunluğu, uzamış ağrı süresi ve artmış inflamatuar yanıt ile ilişkilendirilmiştir. Sonuç olarak, D vitamini düzeyi PHN'nin klinik seyrini tahmin etmek ve uygun tedavi stratejilerini belirlemek için değerli bir biyobelirteç olabilir.

Keywords

• postherpetik nevralji
• d vitamini eksikliği
• dn4 skoru
• nöropatik ağrı
• herpes zoster

Project Number

02.07.2024 tarih ve 12 sayılı

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