Evidence-Based Case Report: The Prevention and Management of Postherpetic Neuralgia With Emphasis on Interventional Procedures. Issue 5 (1st August 2009)

• Record Type: Journal Article
• Authors: Benzon, Honorio T.; Chekka, Kiran; Darnule, Amit; Chung, Brian; Wille, Oscar; Malik, Khalid
• Is Part Of: Regional anesthesia and pain medicine. Volume 34:Issue 5(2009)
• Page Start: 514-521
• Page End: 514-521
• Publication Date: 2009-08-01
• Subjects: Conduction anesthesia -- Periodicals; Pain medicine -- Periodicals; 617.964
• DOI: 10.1097/AAP.0b013e3181b137bd
• Languages: English
• ISSNs: 1098-7339

Abstract

Abstract : Objective: A patient with postherpetic neuralgia (PHN) did not respond to medications, either singly or in combination, or to intrathecal methylprednisolone but responded to intrathecal alcohol. This evidenced-based case management article evaluates and grades the evidence for the prevention and treatment of PHN. Methods: A search of published English-language studies on the prevention and treatment of PHN was made. Results: Randomized clinical studies showed the efficacy of antiviral agents in the prevention of PHN and the use of anticonvulsants, antidepressants, opioids, and Lidoderm patch in the treatment of PHN (level A evidence). The role of epidural local anesthetic and steroid injections in preventing PHN has not been completely established (level B evidence). Intrathecal steroid injections and topical capsaicin may be effective in PHN (level B evidence). No randomized controlled study supports the usefulness of spinal cord stimulation and intrathecal alcohol. Conclusions: Postherpetic neuralgia should be managed pharmacologically. If not effective, intrathecal steroid injections or nerve blocks may be tried. Spinal cord stimulation or intrathecal alcohol should be used only as a last resort.