Clinical experience of pain treatment for postherpetic neuralgia in elderly patients.
BACKGROUND
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following acute herpes zoster infection. The main clinical problem is intractable pain which interferes with activity of daily life and reduces the quality of life in the elderly patients. This retrospective study was to evaluate the outcome of pain treatment for the elderly patients with PHN at the Pain Clinic of Kaohsiung Medical University Hospital.


METHODS
Fifty-eight elderly outpatients with PHN were studied from January 2004 to June 2006. The pain intensity before and after treatment were assessed by patients themselves with numeric pain scale (NPS). The pain treatment included (1) medication with anticonvulsants, opioids and nonsteroidal anti-inflammatory drugs (NSAIDs); (2) nerve block with 0.25% bupivacaine or 1% lidocaine twice a week at the beginning of the treatment. The therapeutic outcome was expressed by pain relief. The reduction of pain and residual pain intensity were evaluated subjectively by the patients themselves with patients' global impression and NPS, respectively, after treatment for one and three months (or last visit). The adverse events throughout the treatment course were analyzed.


RESULTS
(1) The mean age of the patients was 75.1 yr. The number of female PHN sufferers was higher than that of male in all aged groups and the highest incidence was found in the age group of 70-79 (65.5%). The most commonly involved dermatomes were in the thoracic region (82.7%). (2) All patients suffered from severe pain (NPS 8-10) before treatment. (3) The pain management was a combination of medication and nerve block at the beginning of the treatment. Among the medications, gabapentin was prescribed to all the patients and almost all of them (98.3%) required opioids simultaneously and some of them needed additional NSAIDs at the beginning of the treatment. (4) The most common adverse event was somnolence (24.1%). (5) Among the sympathetic blocks, the intercostal nerve block was performed commonly (84.5%). (6) The therapeutic outcome was expressed by pain relief. As to the reduction of pain, 46 cases (79.3%) and 57 cases (98.3%) felt moderate and much improvement after treatment for one and three months (or last visit), respectively. As to residual pain intensity, although none of them got complete pain relief, however, there were 12 cases (20.7%) and 45 cases (77.6%) felt the pain intensity was mild (NPS 1-3) after treatment for one and three months respectively. (7) There was a statistically significant decrease in the pain intensity between before treatment and after treatment for one month and three months.


CONCLUSIONS
Our study results showed that the concurrent combination therapy with proper medications and appropriate nerve blocks could offer satisfactory pain relief in the majority of elderly patients with PHN.
Chau
Siu-Wah
SW
Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, ROC. siwach@kmu.edu.tw
Soo
Lee-Ying
LY
Lu
David Vi
DV
Chen
Tai-I
TI
Cheng
Kuang-I
KI
Chu
Koung-Shing
KS
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block; D051474:Neuralgia, Postherpetic / Q000628:therapy*; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal