Evidence-based case report: the prevention and management of postherpetic neuralgia with emphasis on interventional procedures.
OBJECTIVE
A patient with postherpetic neuralgia (PHN) did not respond to medications, either singly or in combination, or to intrathecal methylprednisolone but responded to intrathecal alcohol. This evidenced-based case management article evaluates and grades the evidence for the prevention and treatment of PHN.


METHODS
A search of published English-language studies on the prevention and treatment of PHN was made.


RESULTS
Randomized clinical studies showed the efficacy of antiviral agents in the prevention of PHN and the use of anticonvulsants, antidepressants, opioids, and Lidoderm patch in the treatment of PHN (level A evidence). The role of epidural local anesthetic and steroid injections in preventing PHN has not been completely established (level B evidence). Intrathecal steroid injections and topical capsaicin may be effective in PHN (level B evidence). No randomized controlled study supports the usefulness of spinal cord stimulation and intrathecal alcohol.


CONCLUSIONS
Postherpetic neuralgia should be managed pharmacologically. If not effective, intrathecal steroid injections or nerve blocks may be tried. Spinal cord stimulation or intrathecal alcohol should be used only as a last resort.
Benzon
Honorio T
HT
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. hbenzon@nmff.org
Chekka
Kiran
K
Darnule
Amit
A
Chung
Brian
B
Wille
Oscar
O
Malik
Khalid
K
D000279:Administration, Cutaneous; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D000927:Anticonvulsants / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004599:Electric Stimulation Therapy; D000431:Ethanol / Q000008:administration & dosage; D019317:Evidence-Based Medicine; D005260:Female; D053061:Herpes Zoster Vaccine; D006801:Humans; D007278:Injections, Spinal; D009407:Nerve Block; D051474:Neuralgia, Postherpetic / Q000517:prevention & control / Q000628:therapy*; D010147:Pain Measurement; D013256:Steroids / Q000008:administration & dosage; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000927:Anticonvulsants; D000998:Antiviral Agents; D053061:Herpes Zoster Vaccine; D013256:Steroids; D000431:Ethanol