[The DREZ lesion as an effective treatment for chronic hypothetically post-herpetic neuropathic pain. Case report and review of literature].
The authors present a case of a 54-year-old woman with a 3-year history of chronic pain syndrome, probably of postherapeutic origin, with diffuse segmentary dermatome characteristics, both somatic and autonomic. The former were exemplified by a constant "burning" skin pain in the representation of Th8-LI dermatomes unilaterally, while the latter by a unilateral visceral pain within the abdominal cavity. Electrophysiological examination indicated a neuropathic origin of the pain, despite the lack of clinically evident sensory deficits and/or hypersensitivity. The pain was so intense that normal walking was difficult for the patient and ineffectiveness of her treatment made her suicidal. Since both pharmacological treatment (non-steroid analgesics, opioids, antidepressants, and anticonvulsants including gabapentin) and minimally invasive methods of treatment (blockades, thermolesions) failed to control pain, she was subjected to surgery. A right-sided DREZ lesion within the Th8-LI dermatomes resulted in a complete pain relief, both within the somatic and autonomic innervation projections, and in the patient's functional recovery.
Koszewski
Waldemar
W
Kliniki Neurochirurgii A.M. w Warszawie.
Jarosz
Jerzy
J
Pernak-De Gast
Janina
J
D002908:Chronic Disease; D005260:Female; D006562:Herpes Zoster / Q000821:virology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000601:surgery* / Q000821:virology*; D010147:Pain Measurement; D013514:Surgical Procedures, Operative / Q000379:methods*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery* / Q000821:virology