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Category Archives: post herpetic neuralgia
Local steroid/local injections can greatly attenuate shingles and post shingles pain yet has received very little notice. I wrote about it in a couple blog notes: Alternate Approaches to Post-Herpetic Neuralgia (PHN) http://painmuse.org/?p=346 Early Fix For Herpetic Zoster/Shingles – Inject … Continue reading
Not a new study but the benefits mandated that I include it. Study presented were 2 cases in their 80’s with severe Post Herpetic Neuralgia – one on face, other T8-10 that tried everything including spinal stimulator without effect. Pain … Continue reading
Post Herpetic Neuralgia (PHN) – Repeat Case – Pulse Radiofrequency (PRF) To Dorsal Root Ganglion Again Works
Case T7 PHN helped by PRF to dorsal root ganglion
Triamcinolone 0.1% topical oral ointment with 500ug B12/2 mg ointment outperformed plain triamcinolone adding credulance that frequent B12 injections into active shingles area helps. Question is whether it needs to be methylcobalamin – B12 bioactive form for best topical effect.
Using 6% gabapentin, 4% amitriptyline, ketoprofen 10%, lidocaine 5%, and ketamine 10% probably in Lipoderm could give some relief topically. Ketamine 100 mg/ml with 0.1 ml spray nasally could give additional relief. 30% mannitol might be good here.
Three IV Magnesium 1mg /k in 100 mls saline infusions over 1 hour – one every other day or Three 1 mg/kg Ketamine in 100 mls saline infused in over 1 hour ketamine one EOD resulted in 7/15 magnesium and … Continue reading
Post-Herpetic Neuralgia – Transforaminal Epidural Steroid Injection Might “Cure” And New Injection Rules
Several case studies have shown that transforaminal steroids could relieve Post Herpetic neuralgia (PHN) but that procedure is under heavy scrutiny because of rare strokes, paralysis and death so use of soluble dexamethasone has been edicted.
I have heard of peripheral nerve stimulators used in cases before but this additional one makes it more mainstream. This one captured control with high frequency
Ramsay Hunt syndrome shingles affects ear canal and associated area about ear, and is very painful and can be associated with facial nerve damage. Two stellate ganglion blocks with “local anesthetic 0.25% bupivacaine and triamcinolone 40 mg were given daily … Continue reading
Pregabalin helps 1 in 4.93 while lidocaine patch helped 1 in 2.. Still, reliance on meds only helped 1/2 then…- there are plenty of alternatives though
I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.
I had a recent question on treatments for PHN…I felt I needed to add more info on Botox for PHN. (Using equivalents) Putting equivalent of 6 units Botox INTRADERMAL per 3.56 cm diameter (1.4 of an inch) diameter area, could … Continue reading
An older study found zoster immune globulin single early infusion could reduce shingles symptoms by 50% at day 42 but this appears to be forgotten. It appears in Canada to be readily available through public health as Varizig – manufactured in Winnipeg … Continue reading
I have written extensively on how nerve root blocks are a necessary part of treatment of shingles. Came across two Chinese articles stating effectiveness – one stating you can get “markedly effective” results in 75% of cases.
Two separate chinese articles discuss use of B12 in the period immediately after shingles and also, in a separate study, later. Each shows benefit. Note should be made that they used methylcobalamin – the bioactive form of B12
Injecting shingles lesion in acute stage with local and steroid reduces pain, improves sleep and purportedly reduces post-herpetic neuralgia. NOTE TO MY CHINESE VIEWERS – I only have access to the chinese abstract translation – if you could fill in gaps … Continue reading
Post Herpetic Neuralgia / Shingles – Micro-knifing Tender Areas (Acupotomy) Reduces Pain 60% and Persists over Course of 6 – 12 Months
Previously, there was a technique involved producing 2nd degree frost burns in tender post-herpetic neuralgia areas – as a means to reduce pains. Suzuki H, Ogawa S, Nakagawa H, et al. Cryocautery of sensitized skin areas for the relief of … Continue reading
The back can have a wide distribution in shingles; and according to a study, is not relable at determining nerve level, as is the front distribution. I will inject dorsal nerve roots in order to shut the back distribution off; often I … Continue reading
A Patient wrote: “My husband has been suffering with “Opthalmic Branch Post-Herpetic Neuralgia” for more than 4.5 years. The area describe here is exactly same as his PHN area. Currently he is taking 600mg Gabapentine 3 times a day and … Continue reading
Transcutaneous Nerve Stimulation (TENS = TNS)with one pad paraspinous and one pad front at level of shingles run 30 min daily – 20-40 hertz and 1-5 milliamps ended up with no pain at 6 months one versus 10% postherpetic neuralgia in … Continue reading
I’m trying to complete my coverage of Post-herpetic Neuralgia (PHN) treatments and felt this was a rather newer innovation. 65% can achieve a significant reduction in pain.
I had a patient on Methotrexate want the shingles vaccine. Had to look this one up…as people with Rheumatoid arthritis and related diseases are on immunosuppressives…
Repeated nerve Blocks work within 100 days of Herpes zoster – quicker results if before the first 20 days
In the scalp, when there are small spots of severe pain, they call it nummular headache areas – they are remarkably resistant to treatments (botox helps though). Similar painful areas the size of the palm were treated with a 2 … Continue reading
In rodents were either afflicted with either: – peripheral nerve injury – string tied about sciatic nerve – sciatica / radiculitis – string tied about a lumbar nerve Botox injections into paw cut senstivity by 50% in the peripheral injury … Continue reading