The role of Vitamin D deficiency in neuropathic pain following Herpes Zoster: a retrospective cohort study

Authors : Seher İlhan, Çağla Erdoğan

Pages : 545-554

Doi:10.18663/tjcl.1762842

View : 51 | Download : 44

Publication Date : 2025-09-30

Article Type : Research Paper

Abstract :significantly impacts quality of life. In this context, the objective of this study is to investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and the severity, duration, and neuropathic symptoms of PHN. Material and Methods: The sample of this retrospective observational cohort study consisted of 71 patients who were followed up with a diagnosis of PHN between January 2020 and June 2024. Patients were stratified into three groups according to their serum 25(OH)D levels as patients with vitamin D deficiency (≤20 ng/mL, n=24), vitamin D insufficiency (21-29 ng/mL, n=26), and vitamin D sufficiency (≥30 ng/mL, n=21). Patients’ neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire and the Numeric rating scale (NRS). Inflammatory parameters such as C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), and leukocyte count were recorded for each patient, and the diagnostic performance of their serum 25(OH)D levels was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The mean DN4 and NRS scores and pain duration of the patients with vitamin D deficiency were significantly higher than those of other patients (5.83±1.76 vs. 1.71±0.96, p<0.001; 8.92±1.59 vs. 6.29±2.43, p=0.001; 93.54±41.23 vs. 31.86±35.80 days, p<0.001; respectively). Serum 25(OH)D level was strongly correlated with DN4 score (r=-0.758; p<0.001), pain duration (r=-0.640; p<0.001) and NRS score (r=-0.497; p<0.001) in the negative direction. Pins-and-needles sensation and brush-evoked pain were significantly more common in patients with vitamin D deficiency than in other patients (p<0.001). Mean CRP and ESR values of patients with vitamin D deficiency were significantly higher than those of other patients (11.99±14.56 vs. 6.99±12.38 mg/L, p=0.046 and 25.71±16.58 vs. 13.75±7.01 mm/hour, p=0.007; respectively). ROC analyses revealed that the optimal serum 25(OH)D cut-off levels to predict patients with a DN4 score ≥4 and pins-and-needles sensation were 21.15 ng/mL (area under the curve [AUC]=0.862) and 25.85 ng/mL (AUC=0.930), respectively. Conclusion: Low serum vitamin D levels were associated with increased neuropathic pain intensity, prolonged pain duration, and increased inflammatory response in patients with PHN. In conclusion, vitamin D level may be a valuable biomarker for predicting the clinical course of PHN and determining appropriate treatment strategies.
Keywords : postherpetik nevralji, d vitamini eksikliği, dn4 skoru, nöropatik ağrı, herpes zoster

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