Evidence for Interventional Procedures as an Adjunct Therapy in the Treatment of Shingles Pain

Abstract

Shingles (herpes zoster) is a painful manifestation of infection of the dorsal root ganglia of the spine and seen as blisters or vesicles in linear formation, usually on the upper torso. Up to one-third of those afflicted will experience complications, with the most common complication being postherpetic neuralgia (PHN). The risk of PHN increases for each decade of life after age 50 years, and the pain associated with this complication has the potential to endure for years, be unrelenting, and decrease an individual's quality of life. Treatment options, including adjunct interventional procedures, are presented to address the common complication of PHN. Although no conclusive evidence base is present for the use of any particular interventional procedure in the treatment of acute pain or refractory pain of shingles, a number of therapies have been indicated to have some level of effectiveness. Standard therapy options in the form of oral medications and topical agents should be used first. For those situations of refractory pain, a referral to an interventional pain management specialist is warranted to explore possible adjunct procedures to lessen the pain of PHN. A comprehensive care management approach, incorporating interventional pain management procedures as an adjunct therapy, will enable patients to have their pain treated as effectively as possible by utilizing appropriate methods available.

Effect of Ultrasound‐Guided Intercostal Nerve Block Versus Fluoroscopy‐Guided Epidural Nerve Block in Patients With Thoracic Herpes Zoster: A Comparative Study

“…This stimulating signal causes neuronal ischemia and, eventually, concomitant inflammation of the peripheral nerve, especially the large myelinated nerve fiber. Thus, various sympathetic nervous system blockades for stopping irreversible nerve damage would be useful for pain control in patients with HZ …”

“…Herpes zoster (HZ) results from reactivation of the latent varicella zoster virus after the primary infection . Especially for elderly patients, when cell‐mediated immunity wanes, common symptoms of HZ appear, primarily as pain in a dermatomal distribution with a burning, sharp pain sensation (paresthesia) and itching, in addition to development of a vesicular rash . When reactivation in 1 or more dorsal root ganglia occurs, a unilateral thoracic dermatome most frequently occurs (55%), followed by trigeminal nerve (20%), cervical (11%), lumbar (13%), and sacral (2%) dermatomes .…”

“…The reported incidence of PHN is 9% to 45% of all cases of HZ. Postherpetic neuralgia can decrease the quality of life because of reduced sensitivity, abnormal sensations, and chronic pain frequently associated with allodynia, a pain response to a usually nonpainful touch or pressure …”

Superficial cervical plexus block for management of herpes zoster neuralgia in the C3 dermatome: a case report

“…If the employed intervention is effective, it is repeated until pain is markedly improved; if not, then other interventions (that is, sympathetic neurolysis, spinal cord stimulation, peripheral nerve stimulation, pulsed radiofrequency lesioning or radiofrequency thermocoagulation of the dorsal root ganglion). Even though a number of methods, including those noted above, have been proposed, personalized or tailored treatment in consideration of specific effectiveness and prognosis is best [2,4,10]. Among the effective interventional therapies, SGB, a type of sympathetic nervous system blockade, can help to reduce HZ pain above the T3-dermatome level as a result of interaction between the sympathetic nervous system and the damaged nerve [2-4,10,11].…”

“…Even though a number of methods, including those noted above, have been proposed, personalized or tailored treatment in consideration of specific effectiveness and prognosis is best [2,4,10]. Among the effective interventional therapies, SGB, a type of sympathetic nervous system blockade, can help to reduce HZ pain above the T3-dermatome level as a result of interaction between the sympathetic nervous system and the damaged nerve [2-4,10,11]. In the present case, the initial SGB procedure allowed our patient to sleep well at night, and was administered at least three times per week.…”