Peng
Weak evidence that HBOT is of benefit in the treatment of patients with herpes zoster
Clinical bottom line:
| 1. HBO may speed resolution of pain and rash from herpes zoster |
Citation: Peng Z, Wang S, Huang X, Xiao P. Effect of hyperbaric oxygen therapy on patients with herpes zoster. Undersea Hyperb Med 2012;39(6):1083-1087. Lead author's name and email: Zhengrong Peng: pengzr138@yahoo.com.cn
Three-part Clinical Question: For patients with herpes zoster, does the addition of hyperbaric oxygen to standard care reduce the symptoms of the infection?
Search Terms: Herpes zoster, post-herpetic neuralgia
The Study: Non-blinded randomized controlled trial without intention-to-treat. The Study Patients: Patients diagnosed with herpes zoster for less than 2 weeks
Control group (N = 32; 32 analysed): Pharmacological treatment for herpes zoster (acyclovir, mecobalamin, tramadol hydrochloride, nortriptyline). No sham treatment.
Experimental group (N = 36; 36 analysed): As above, but patients were given 30 sessions of HBOT, twice daily, at 2.2 ATA breathing 100% oxygen for 80 minutes.
The Evidence:
Outcome |
Time to Outcome |
Sham event rate |
HBO event rate |
Relative risk reduction |
Absolute risk reduction |
NNT |
|
Complete Healing |
3weeks |
0.53 |
0.61 |
15% |
0.08 |
13 |
95% CI: |
-2% to 59% |
-0.2 to 0.3 |
NNT 3 to INF; | |||
|
Therapeutic Efficacy |
3weeks |
0.81 |
0.97 |
20% |
0.16 |
6 |
|
^ |
95% CI: |
2% to 38% |
0.01 to 0.31 |
3 to 70 |
Measure |
Control Group |
HBOT Group |
Difference |
95% CI | |||||
|
^ |
Mean |
SD |
Mean |
SD |
|||||
|
Numeric Pain Rating Scale |
3.5 |
4.1 |
1.8 |
2.7 |
1.7 |
0.04 to 3.4 | |||
|
Hamilton Depression Rating Scale |
10.9 |
9.7 |
16.5 |
12.0 |
5.6 |
0.3 to 1 | |||
Comments
1. Study outcomes measured when the natural history suggests the infection would have resolved (5 weeks).
2. The un-blinded study design with no sham may have contributed to patient and investigator bias and a placebo effect.
3. The study methodology was poorly reported.
4. No significant difference in the number of patients who healed in each group.
5. Probably no clinical significance in small difference in the NPRS scores.
6. HAMD scale may not be an appropriate tool. The authors’ conclusion that HBOT is beneficial to depression is not reflected in the results.
7. Results seem analyzed with intention-to-treat, despite the authors claiming that subject drop-outs were excluded from analysis.
Appraised by: Alan Bourke & Bryan Hui; Wednesday, 24 June 2013 Email: [bryan.hui@unsw.edu.au]
Kill or Update By: July 2015
