Clinical and psychosocial correlates of acute pain in herpes zoster

Background: Acute and persistent pain are the most significant clinical manifestations of herpes zoster (HZ), but the characteristics of acute pain in HZ patients have been inadequately investigated. Objectives: To correlate the severity of acute pain with clinical, demographic and psychosocial characteristics of HZ patients. Study design: Five hundred thirty-three patients with acute HZ were recruited by 119 dermatologists who collected medical and demographic data at diagnosis, provided counselling and therapy where appropriate and asked the patients to complete the Short Italian Questionnaire designed for comprehensive evaluation of HZ patients. Results: In a univariate analysis, greater acute pain severity was significantly associated with female gender, number of dermatomes affected, presence of prodromal pain, abnormal sensations (dysesthesia), education level, anxiety and depression. Quality of life, even if greatly reduced, did not correlate with the intensity of pain. In a multivariate model, the intensity of pain was independently associated with the extent of rash (p = 0.042), presence of prodromal pain (p = 0.005), dysesthesia, education level (p = 0.040), and depression (p < 0.001), but not with gender, anxiety or quality of life. Conclusions: This study suggests that in patients with acute HZ the severity of the disease and depression at presentation are the main correlates of pain intensity. (c) 2007 Elsevier B.V. All rights reserved.