From Acute to Chronic

Introduction: Herpes zoster-related pain has different phases, and the changes in glymphatic function during disease development are unknown. This study investigated stage-dependent changes in glymphatic function and mood scale scores in patients with herpes zoster-related pain, including their interrelationships. Methods: A total of 43 patients with herpes zoster (HZ), 54 patients with subacute herpetic neuralgia (SHN), 37 patients with postherpetic neuralgia (PHN) and 30 healthy controls (HC) were ultimately included as study subjects. Diffusion tensor imaging analysis of the perivascular space (DTI-ALPS) index was used to evaluate glymphatic function. All patients were assessed with the visual analog scale (VAS), the 90-item Symptom Checklist-90-Revised (SCL-90-R), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA). ANOVA was used to determine whether there was a difference in the DTI-ALPS index among the 4 groups. Spearman’s correlation analysis was used to determine the correlation between the DTI-ALPS index and each clinical scale. Results: DTI-ALPS indices were significantly lower on the left and right sides and mean in the PHN group than in the HC group (left: P =0.025; right: P =0.014; mean: P =0.006). HAMA, HAMD, VAS-SCL-90-R, and HAMD-SCL-90-R scores showed significant positive/negative correlations across all three groups, whereas the HAMA-SCL-90-R correlation was significant in the SHN and PHN groups. Discussion: Glymphatic dysfunction is observed in cases of zoster pain chronification, and the severity of mood disorders increases across disease stages. These findings provide both a clinical reference for how to qualify patients more comprehensively and a neuroimaging aspect to explore the mechanisms of PHN pathogenesis.