Evidence-based case report the prevention and management of postherpetic neuralgia with emphasis on interventional procedures

Honorio T. Benzon, Kiran Chekka, Amit Darnule, Brian Chung, Oscar Wille, Khalid Malik

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)514-521
Number of pages8
JournalRegional anesthesia and pain medicine
Volume34
Issue number5
DOIs
StatePublished - Sep 1 2009

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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