The effect of immunological marker levels on the development of postherpetic neuralgi̇a due to acute herpes zoster in patients with di̇abetes mellitus

Purpose: Neuropathic pain is pain arising from a lesion or disease of the somatosensory system and its pathogenesis has not been clearly revealed yet. Recent studies all over the world suggest that immunological mechanisms play an active role. In this study, the role of immune mechanisms in the progression to Postherpetic Neuralgia (PHN), which is a cause of neuropathic pain, and the effect of Diabetes Mellitus on immune markers were investigated in patients suffering from Acute Herpes Zoster (AHZ). Method: Twenty patients with neuropathic pain after acute Herpes Zoster were included in the study. Ten patients with diabetes mellitus were divided into group I and 10 patients without diabetes mellitus were divided into two groups as group II. At the first admission, hemogram, C-Reactive Protein (CRP), sedimentation (ESR), hemoglobin A1c, blood glucose measurements were studied. Immunological marker levels were studied from the same blood samples. Control blood values and immunological marker levels were studied in the blood samples taken at the control examination at the 3rd month by calling the patients at regular intervals. Numerical rating scale (NRS) was used to measure the pain severity of the patients, sleep interference scoring (SIS) to measure the effect of pain on sleep, and DN4 for the evaluation of neuropathic pain. pain scoring was used. In our study, in accordance with the literature, CD3+, CD4+, CD8+, T regulatory (Foxp3), NK (defective, cytotoxic and regulatory subunits), NK CD56 (bright and dim subunits) and NK CD57 cell levels were studied in order to evaluate the role of immunological mechanisms in the formation and chronicity of neuropathic pain. . Results: The demographic characteristics of the patients in groups I and II included in our study were similar. Among the routine laboratory tests, the CRP and sedimentation (ESR) values of the patients in group II decreased significantly with treatment; There was no significant change in the diabetic group. When the immunological markers were compared, when the values of the patients in groups I and II were compared, the values studied at the beginning of the NK defective subset and at the end of the treatment were statistically different. Considering the changes in immune markers in the group at the beginning and at the 3rd month; While CD3+, CD4+, CD8+ values decreased significantly with treatment in the diabetic group, defective subset and regulatory subset values, which are NK cell subsets, decreased significantly in the non-diabetic group. Apart from this, the change in other immunological marker levels in groups I and II was not statistically significant. Conclusion: In our study, it was aimed to show the effect of the presence of diabetes mellitus on the transformation of shingles pain into chronic postherpetic neuralgia and on cytokines. Regardless of the presence of diabetes mellitus, chronic pain can be prevented in patients who receive appropriate treatment in the early stages of the disease. Larger randomized prospective studies are needed to investigate the effect of diabetes melltius on immune markers in patients who develop postherpetic neuralgia. In addition, the possibility of inhibition on cytokine levels of gabapentinoid-type adjuvant agents used to control neuropathic pain symptoms related to AHZ should be considered, and large-scale studies including healthy control groups are needed. Keywords: Postherpetic Neuralgia, Neuropathic pain, cytokines, diabetes mellitus