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Successful treatment of pain in post-herpetic nueuralgia with the venom of Apis Mellifera |
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Presented
at the third International Varicella Zoster Research Foundation meeting
March 2001 Post-herpetic neuralgia (PHN) is the pain that persists for more than four months following the onset of the rash associated with a herpes zoster (shingles) outbreak. PHN pain is generally characterized by severe unrelenting pain described by patients as either deep aching, burning, sharp, jabbing, electrical, lancinating or a combination of these. Frequently allodynia is a disabling sign. The longer the pain persists the longer it is likely to continue, and many of these elderly patients die with their pain never resolving. The current treatment of post-herpetic neuralgia is unsatisfactory to most sufferers and strictly palliative in nature. These treatments involve tedious repetitive procedures or the taking of medications that may have serious side effects. None of these interventions alter the natural history of the condition. They just decrease the symptoms until spontaneous resolution occurs - if it resolves at all. Treating pain with the venom of the European honeybee, Apis mellifera, dates back several thousand years. Hippocrates and Celsus documented the use of bee venom as a medical treatment. The most frequent use of bee venom today is the treatment of inflammatory arthritis. There are over 20 biologically active peptides in Apis mellifera venom, some of which are anti-inflammatory and others neurotoxic in nature. Animal studies confirm the anti-inflammatory properties of bee venom and it=s ability to suppress adjuvant induced arthritis. Fourteen PHN patients (average age 72) who suffered pain for an average of 46.1 months (range 5 to 131) were injected at multiple sites (range 3 to 30) with 100 micrograms of dried bee venom in 0.1 cc of 0.5% lidocaine. These sites corresponded to the location of the greatest pain, origins of shooting pain and to areas of cutaneous scarring. The median interval between the first and second visit was three days. Subsequent visits were four days apart. Patients received an average of 14 treatments over a period of 11.7 " 5.4 weeks. The mean Visual Analog Scale (VAS) pain score at the beginning of treatment was 7.6 " 0.39 and at the end was 2.1 " 1.1, representing a mean decrease of 5.5 " 1.1 (p < 0.001). As a group there was a significant decrease in VAS score (p<0.02) after the first treatment. Patients noted a significant decrease in the stabbing component of their pain within two treatments (p<0.01). They also reported a significant decrease in allodynia after one treatment (p<0.02). The difference of the VAS score at the fifth visit and the end of treatment was not significant; thus, in most cases, full benefit was achieved following the fourth treatment. At follow-up, which averaged 21 months from completion of treatment, the group had a mean VAS score of 2.6 " 1.6, with 4 of the patients pain-free. Initially, 6 patients were taking antidepressants and 4 were taking opioids. By the end of treatment, all 6 patients stopped antidepressants and 3 stopped opioids. Sleep quality improved significantly from the beginning to the end of treatment and continued to be good at follow-up (p<0.001). Most patients reported sleeping better after the first treatment. The results of treatment in these patients suggest that one or more components of honeybee venom are able to decrease the pain of PHN within four treatments on the average by more than 70%, and in some cases completely. These results are maintained long-term. Treatment with bee venom caused positive changes and gave these patients a significantly better quality of life. Related Links The following are links to various published papers and organizations of interest:
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