Managing severe pains that persist - abstract

One of the commonest examples of severe pain that persists long after the injury or disease initiating it has ceased to be active is the neuralgia complicating herpes-zoster. A large variety of treatments have been used to treat acute herpetic and post-herpetic neuralgia, with disappointing results. The treatment of choice should have a low risk of damaging the patient and should relieve acute herpetic neuralgia of all grades of severity, prevent post-herpetic neuralgia and effectively relieve neuralgia at all sites in all patients. In this study, 40 patients with acute herpetic neuralgia and 15 patients with post-herpetic neuralgia were treated with sympathetic blocks (SB). It was possible to follow up 30 (66.6 percent) of the patients with neuralgia treated in the acute stage and 12 (80 percent) of the patients with post-herpetic neuralgia for one or more years after treatment. Effective and permanent relief was achieved in all patients if SBs were given within 3 weeks of the onset of the neuralgia in the acute stage of the disease. In patients with post-herpetic neuralgia of 6 months' duration or less, SBs gave complete relief to 41.6 percent and partial relief to 41.7 percent. The results of this study justify the conclusion that SBs satisfy the criteria necessary for treating acute herpetic neuralgia effectively. The rate of success of SBs in treating post-herpetic neuralgia is high enough to make them the preferred method of treatment in this neuralgia (AU)

The management of herpetic and post herpetic neuralgia - abstract

Herpetic and post herpetic neuralgia, two of the most distressing complications of herpes zoster, are not uncommon and in a period of 10 years since October, 1961, I have treated 21 patients, 18 females and 3 males with neuralgia complicating herpes zoster. Fourteen patients presented with neuralgia during the herpetic stage and 7 in the post herpetic stage. In these 7, duration of pain reported varied from 2 weeks to 3 years. Ten patients had very severe pain and 11 patients severe pain. I regarded the pain experienced as severe when it distrubed sleep and other bodily functions, and required narcotic medication for its control; and very severe when it persisted despite narcotic medication. On five occasions the cranial nerves were involved. The 5th four times and the 7th together with the 8th once. In the 4 patients with 5th nerve involvement, the ophthalmic division alone was involved once, the ophthalmic and maxillary division together once, and the mandibular division twice; once alone, and one together with the cervical roots. The cervical roots were involved alone four times, the thoracic roots nine times, and the lumbar roots three times. The patient with 7th and 8th nerve involvement developed in addition an herpetic irido cyclitis and there were unequivocal signs of encephalitis in 3 of the patients with cranial nerve involvement. Three patients were in their 6th decade, 7 in the 7th and 11 over 70 years old. Stellate ganglion blocks were used for treating neuralgias of the head and neck and upper thoracic roots which paravertebral sympathetic blocks and epidural blocks (lumbar and caudal were used for neuralgias of the lower thoracic and lumbar region. Thirteen patients were given complete and lasting relief and 6 patients partial relief, i.e. their pain was reduced to such an extent that it could be controlled by such analgesics as aspirin and paracetamol. In additional there were 2 patients who reported complete relief up to 7 days after their last treatment, whom I have been able to trace at follow-up. The number of analgesic blocks required for pain relief varied. The patient with involvement of the 7th and 8th nerves required as many as fifteen blocks. But in the majority one or two blocks sufficed (AU)