TY - JOUR
T1 - Evidence-based case report the prevention and management of postherpetic neuralgia with emphasis on interventional procedures
AU - Benzon, Honorio T.
AU - Chekka, Kiran
AU - Darnule, Amit
AU - Chung, Brian
AU - Wille, Oscar
AU - Malik, Khalid
PY - 2009/9/1
Y1 - 2009/9/1
N2 - 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.
AB - 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.
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U2 - 10.1097/AAP.0b013e3181b137bd
DO - 10.1097/AAP.0b013e3181b137bd
M3 - Article
C2 - 19920429
AN - SCOPUS:74549215077
VL - 34
SP - 514
EP - 521
JO - Regional Anesthesia and Pain Medicine
JF - Regional Anesthesia and Pain Medicine
SN - 1098-7339
IS - 5
ER -