Relief of post-herpetic neuralgia by surgical removal of painful skin: 5 years later.
Surgical removal of painful skin was first attempted as a treatment for chronic intractable post-herpetic neuralgia (PHN) more than a century ago, but long-term follow-up has rarely been reported. A patient who underwent surgical excision of 294cm(2) of thoracic skin comprising the entire area of pain and allodynia in October 2000 has been followed for 5.5years post-surgery. Our initial report presented evidence of benefit in the form of reduced pain, elimination of allodynia, and reduced medication consumption during the first post-operative year. Unfortunately, pain steadily increased and now exceeds pre-surgery levels despite increased medication use. Pain topography and characteristics are different from pre-surgery and may relate to the pathophysiology of PHN. Skin resection cannot be recommended as a treatment for PHN.
Petersen
Karin Lottrup
KL
UCSF Pain Clinical Research Center, Department of Neurology, University of California, San Francisco, CA 94115, USA. karin.petersen@ucsf.edu
Rowbotham
Michael C
MC
D000368:Aged; D062109:Dermatologic Surgical Procedures; D006562:Herpes Zoster / Q000150:complications* / Q000601:surgery*; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology* / Q000601:surgery*; D008297:Male; D009437:Neuralgia / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome