A recent study explored the efficacy and feasibility of cognitive behavioral therapy (CBT) along with pregabalin and compared it with pregabalin monotherapy for the management of neuropathic pain in post-herpetic neuralgia (PHN) patients and also explored the modulation of messenger RNA (mRNA) expression of interleukin (IL)-6 and mammalian target of rapamycin-1 (mTORC1) genes in these patients.

The study enrolled patients (aged >18 years) with an established diagnosis of PHN with evident allodynia and hyperalgesia who experienced pain for at least 3 months after healing of rash with pain intensity ≥4/10 on the NRS-Pain Scale. 

The type and duration of pain and disability using pain-relevant self-report questionnaires were recorded at baseline. 2mL venous blood samples were collected for gene expression studies at baseline and at the end of 12 weeks of treatment. Patients were randomized into either Group PR (pregabalin) or Group CP (CBT along with pregabalin). 

A numeric rating scale (NRS)-pain scale, Neuropathic Pain Symptom Inventory (NPSI) and Pain Detect Questionnaire (PDQ), NRS-Sleep, Pain Catastrophizing Scale (PCS), Beck Depression Inventory-II (BDI-II) and Short Form-12 (SF-12), were utilized to assess the outcomes. 

The study enrolled 40 patients. After the intervention, Group CP showed significant downregulation of mRNA expression of IL-6, but not mTOR expression. It also showed a significant decline in the intensity of pain, NPSI scoring for burning, allodynia, and pain-related catastrophizing; along with an improvement in depressive symptoms and quality of life.

Thus, CBT can be used as a clinical adjunct along with pregabalin in patients with PHN.

Pain Medicine. 2021;22(10): 2276–2282. https://doi.org/10.1093/pm/pnab142