Confirmed Again – Local + Steroid Injections Help 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)

Early Fix For Herpetic Zoster/Shingles – Inject the Spots With Local and Steroid

Now a controlled trial found pains in 12.8% of injection treated group versus 47.8% in the standard treatment group (P<0.001)
Cui, Ji-zheng, et al.
Effect of Repetitive Intracutaneous Injections with Local Anesthetics and Steroids for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia.
Pain Medicine 18.8 (2016): 1566-1572.

  • 96 cases  with acute thoracic herpes zoster –  48control, 48 active group
  • “intracutaneous injections of 15 ml 0.25% ropivacaine and 40 mg methylprednisolone every 48 h for a week (total 4 injections)”
  • Verbatum technique:

“The areas injected were determined according to the distribution of the skin lesions and nerve segmental distribution of the pain. The intracutaneous injections were placed along the midclavicular line, axillary line, and subscapularis line as determined by the dermtomal distribution of pain and the rash.

For example, in one patient, the dermtomal distribution of pain and the lesion was T4–T6 on the right side of the body, so the solutions were injected into the right side of the midclavicular line, axillary line, and subscapularis line between T4 and T6 (Figure 1).”

“Maximum therapeutic effect cannot be anticipated unless all of the affected areas are injected. Therefore, the areas of eruption or sites of pain, burning, or itching were also selectively injected, and special consideration was given to the most painful areas.”

  • injection group significantly shorter duration of pain (25.7  vs 58. days)
  • significantly shorter duration of herpetic eruption and skin healing (17.9 vs 30.8 days)
  • post herpetic neuralgia rates: active vs control
    1 month – 12.8% vs 47.8%, P <0.001),
    3 months (6.4% vs 28.3%, P =0.005)
    6 months (4.3% vs 17.4%,  P=0.022).

Comment – When I saw active lesions, I was some reticent to inject into those areas, now I and reticent NOT TO inject them… Fot G’ds sake inject them while they are hot and they cool down without scarring in pain. Having said that, injecting post herpetic neuraliga cases with steroid/local is very beneficial as well but will need repeated courses. It’s important to get areas so it is no longer painful at time so you know infusion has got all sites.

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