The management of herpetic and post herpetic neuralgia - abstract

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)