New Meta-Analysis Identifies Emerging Risk Factors for Postherpetic Neuralgia
China: A recent meta-analysis published in the Journal of Pain Research has shed light on newly identified risk factors contributing to postherpetic neuralgia (PHN).
Bing Liang from the Department of Pain Therapeutics, School of Anesthesiology, Naval Medical University, Shanghai, and colleagues analyzed data spanning from 2014 to 2024, providing updated insights that may refine clinicians’ understanding and improve prevention strategies for this debilitating condition.
Postherpetic neuralgia, a chronic pain complication that can follow herpes zoster (shingles), continues to be a major public health concern due to its significant impact on patients’ quality of life. While older age and severe rash have long been recognized as established risk factors, this systematic review and meta-analysis is among the first to comprehensively evaluate additional predictors identified over the past decade.
The researchers systematically searched multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library, for cohort and case-control studies conducted between January 2014 and March 2024. The quality of the included studies was evaluated using the Agency for Healthcare Research and Quality (AHRQ) criteria and the Newcastle–Ottawa Scale (NOS). Ultimately, 17 studies comprising 124,078 participants were analyzed, identifying 81 possible risk factors for PHN. Eleven of these factors were subjected to quantitative synthesis.
Key Findings:
- Higher age was a strong predictor of PHN, with individuals aged 60–69 having over twice the risk (OR 2.05) and those aged above 70 having more than triple the risk (OR 3.08) compared to younger individuals.
- Severe rash was associated with an increased likelihood of developing PHN.
- Greater acute pain severity significantly raised the risk (OR 2.01).
- Anxiety or depression increased PHN risk (OR 1.30).
- Diabetes mellitus was linked to a higher risk (OR 1.46).
- Malignancy was identified as a contributing risk factor (OR 1.56).
- Chronic obstructive pulmonary disease (COPD) elevated the risk (OR 1.88).
- Hypertension was found to modestly increase PHN risk (OR 1.22).
- Peptic ulcer disease showed a strong association with PHN (OR 3.71).
- No significant association was observed between PHN and female sex (OR 0.69).
- Inflammatory markers were not significantly linked to PHN (OR 1.01).
The authors advised cautious interpretation of the results, noting that inclusion of only English-language studies may have introduced bias. Differences in PHN definitions (3–6 months of pain) and small sample sizes across studies could also have affected data consistency and the reliability of pooled outcomes.
The decade-long analysis highlights five newly recognized risk factors for PHN—psychological disorders, COPD, hypertension, malignancy, and peptic ulcer disease. These insights could enhance clinical prediction models and guide preventive measures in high-risk individuals.
The authors advocate for large-scale, multicenter research to validate these findings and establish standardized diagnostic criteria. Strengthening the evidence base on PHN’s evolving risk profile could ultimately improve early detection, management, and patient outcomes.
Reference:
Liang B, Wan Y, Su X, Pan X, Zhang Z, Guo X, Li M. New Findings on Risk Factors for Postherpetic Neuralgia From 2014 to 2024: A Systematic Review and Meta-Analysis. J Pain Res. 2025;18:5631-5643. https://doi.org/10.2147/JPR.S552774
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