Such interventions would have the potential to reduce the prevalence of chronic pain in the population .
Although certain risk factors can identify individuals who are most likely to develop chronic pain , few interventions to prevent chronic pain have been identified .
To facilitate the identification of preventive interventions , an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain .
We present general design considerations for prevention trials in population s that are at relatively high risk for developing chronic pain .
The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: a randomised controlled trial
BACKGROUND Postherpetic neuralgia is the most frequent complication of herpes zoster . Treatment of this neuropathic pain syndrome is difficult and often disappointing . We assessed the effectiveness of a single epidural injection of steroids and local anaesthetics for prevention of postherpetic neuralgia in older patients with herpes zoster . METHODS We r and omly assigned 598 patients older than 50 years , with acute herpes zoster ( rash < 7 days ) below dermatome C6 , to receive either st and ard therapy ( oral antivirals and analgesics ) or st and ard therapy with one additional epidural injection of 80 mg methylprednisolone acetate and 10 mg bupivacaine . The primary endpoint was the proportion of patients with zoster-associated pain 1 month after inclusion . Analyses were by intention-to-treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N32866390 . FINDINGS At 1 month , 137 ( 48 % ) patients in the epidural group reported pain compared with 164 ( 58 % ) in the control group ( relative risk [ RR ] 0.83 , 95 % CI 0.71 - 0.97 , p=0.02 ) . After 3 months these values were 58 ( 21 % ) and 63 ( 24 % ) respectively ( 0.89 , 0.65 - 1.21 , p=0.47 ) and , at 6 months , 39 ( 15 % ) and 44 ( 17 % ; 0.85 , 0.57 - 1.13 , p=0.43 ) . We detected no subgroups in which the relative risk for pain 1 month after inclusion substantially differed from the overall estimate . No patient had major adverse events related to epidural injection . INTERPRETATION A single epidural injection of steroids and local anaesthetics in the acute phase of herpes zoster has a modest effect in reducing zoster-associated pain for 1 month . This treatment is not effective for prevention of long-term postherpetic neuralgia
Such interventions would have the potential to reduce the prevalence of chronic pain in the population .
Although certain risk factors can identify individuals who are most likely to develop chronic pain , few interventions to prevent chronic pain have been identified .
To facilitate the identification of preventive interventions , an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain .
We present general design considerations for prevention trials in population s that are at relatively high risk for developing chronic pain .