From Acute to Chronic: An Analysis of Neuroimaging and the Psychological Evolution of Herpes Zoster-related Pain.

INTRODUCTION

Herpes zoster-related pain has different phases, and the changes in glymphatic function during disease development are unknown. This study investigated stage-dependent changes in glymphatic function and mood scale scores in patients with herpes zoster-related pain, including their interrelationships.

METHODS

A total of 43 patients with herpes zoster (HZ), 54 with subacute herpetic neuralgia (SHN), 37 with postherpetic neuralgia (PHN) and 30 pain-free controls (PFC) were ultimately included in this study. Diffusion tensor imaging analysis of the perivascular space (DTI-ALPS) index was used to evaluate glymphatic function. All participants were assessed with the visual analog scale (VAS), the 90-item Symptom Checklist-90-Revised (SCL-90-R), the Hamilton Depression Scale (HAMD), and the Hamilton Anxiety Scale (HAMA). Analysis of Varivance (ANOVA) was used to determine whether there was a difference in the DTI-ALPS index among the 4 groups. Spearman correlation analysis was used to determine the correlation between the DTI-ALPS index and each clinical scale.

RESULTS

DTI-ALPS indices were significantly lower on the left and right sides and mean in the PHN group than in the PFC group (left: P =0.025; right: P =0.014; mean: P =0.006). HAMA, HAMD, VAS-SCL-90-R, and HAMD-SCL-90-R scores showed significant positive/negative correlations across all 3 patient groups, whereas the HAMA-SCL-90-R correlation was significant in the SHN and PHN groups.

DISCUSSION: Glymphatic dysfunction is observed in cases of zoster pain chronification, and the severity of mood disorders increases across disease stages. These findings provide both a clinical reference for how to qualify patients more comprehensively and a neuroimaging aspect to explore the mechanisms of PHN pathogenesis.