Immunological mechanism of postherpetic neuralgia and effect of pregabalin treatment on the mechanism: a prospective single-arm observational study

BACKGROUND: Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system’s role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. METHODS: Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh CD4(+)CXCR5(+)PD1(+)), Th17 (CD4(+)CCR6(+) and CD4(+)IL17A(+)), regulatory T cells (Treg CD4(+) CD25(+)foxp3(+)), Th1 (CD4(+) CXCR3(+) and CD4(+) IFN-γ(+)) and Th2 (CD4(+) IL-4(+)) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. RESULTS: When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3(+), CD4(+)) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase (P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase (P = 0.036). CONCLUSIONS: Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.