Postherpetic pain: more than sensory neuralgia?
OBJECTIVE
To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster.


METHODS
Case series.


METHODS
Outpatient older adult pain clinic.


METHODS
Five older adults are presented with myofascial pain that developed as a complication of herpes zoster.


RESULTS
Pain duration at the time of presentation ranged from 4 months to 7 years. All patients reported functional impairment from pain despite oral analgesics. Myofascial pathology was diagnosed by the presence of taut bands and trigger points in the affected myotome. Upon successful treatment of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, trigger point injections, dry needling, and/or percutaneous electrical nerve stimulation), all patients reported symptomatic improvement, and four out of five were able to significantly reduce or discontinue their opioids.


CONCLUSIONS
Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed.
Weiner
Debra K
DK
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15206, USA. dweiner@pitt.edu
Schmader
Kenneth E
KE
D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D009209:Myofascial Pain Syndromes / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D051474:Neuralgia, Postherpetic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*