Efficacy of intermittent epidural dexamethasone bolus for zoster-associated pain beyond the acute phase

Abstract

Herpes zoster develops when latent varicella zoster virus is reactivated in the trigeminal or dorsal root ganglions. Zoster-associated pain (ZAP) is neuropathic pain caused by the herpes zoster virus. Histological studies of postherpetic neuralgia patients suggest that inflammation is involved in ZAP. The effectiveness of local anesthetic and steroid epidural injections in ZAP patients has been reported. However, most studies included patients with acute herpes zoster, and the safety and therapeutic effects of different doses of epidural steroids in ZAP patients remain elusive. In this study, we randomly assigned 42 patients with severe ZAP beyond the acute phase, as determined by a numeric rating scale (NRS) score ≥7, to receive continuous epidural infusion of local anesthetics with either a one-time 5-mg dose or intermittent repeated doses (15 mg total) of dexamethasone. We found that intermittent repeated epidural dexamethasone bolus resulted in reduced NRS scores and an increased likelihood of complete remission in ZAP patients without any adverse effects. Thus, our results suggest that intermittent repeated epidural dexamethasone administration is safe and effective for treatment of ZAP beyond the acute phase.

Effect of CT-Guided Gasserian Ganglion Block with Local Anesthetics and Steroids on Acute/Subacute Zoster-Related Trigeminal Neuralgia: A Multicenter Retrospective Study

“…The application of nerve block has been proven to be safe in the treatment of herpes zoster. 18 , 19 Consistent with previous reports, all patients in this study had no drug-related serious adverse effects and all punctures were performed under CT guidance without puncture-related serious adverse effects. Bradycardia occurred in some patients while the foramen ovale was being punctured; all of whom recovered spontaneously without treatment.…”

“… 17 In addition, favorable outcomes for epidural or paravertebral blocks have also been reported. 18 , 19 However, only few reports on nerve block in the treatment of acute zoster-related trigeminal neuralgia are available. Philippe Gain performed daily frontal and/or nasal blocks with bupivacaine plus adrenaline added to clonidine, which relieved severe pain in acute ophthalmic zoster.…”

Radiofrequency regulation of the sphenopalatine ganglion in managing herpes zoster ophthalmicus neuralgia: A case series

“…The head and face are high-risk or sensitive areas for herpes zoster complicated with postherpetic neuralgia; further, the intensity of pain in the head and face postherpetic neuralgia is generally more severe, significantly impacting daily activities such as eating, washing, and sleeping. Given the unique location of the affected area, achieving continuous nerve block, [5] spinal cord electrical stimulation, and intrathecal morphine pumps is challenging, which increases the treatment difficulty. Currently, their effectiveness in rapid analgesia, shortening the disease course, and reducing the incidence of postherpetic neuralgia is unsatisfactory.…”

Extracellular signal-regulated kinase phosphorylation enhancement and NaV1.7 sodium channel upregulation in rat dorsal root ganglia neurons contribute to resiniferatoxin-induced neuropathic pain: The efficacy and mechanism of pulsed radiofrequency therapy

“…Neuropathic pain caused by herpes zoster is called zoster-associated pain (ZAP). 2 Herpes zoster is caused by recurrent varicella-zoster virus (VZV) infection. VZV latently infects the cerebral and spinal ganglia even after the initial infection is cured, and develops as herpes zoster when cell-mediated immunity decreases due to aging or immunosuppressive conditions.…”