Cervical epidural infusion for the treatment of herpes zoster pain. Case report with review of the literature
Keywords:
Herpes zoster, Injections epidural, Chronic pain, Neuralgia postherpetic, Glucocorticoids
Abstract
Introduction: Herpes zoster is caused by a reactivation of the varicella zoster virus. Clinically, the disease manifests with pain in the area of a dermatome associated with vesicular exanthema. The most common complication is post-herpetic neuralgia, more frequent among elderly patients. The treatment focuses on the control of the acute infection, relief of acute pain, and prevention of chronic pain. First line treatment is pharmacological using antiviral and analgesic drugs, and epidural injections have been used for the prevention of post-herpetic neuralgia.
Objective: The objective of this article is to present a review of the literature on the basis of a case report of a patient diagnosed with herpes zoster who was treated with cervical epidural infusions for 16 days.
Materials and methods: Search conducted in PUBMED, including meta-analyses, systematic reviews, clinical trials, narrative reviews and case series published between 1995 and 2012, in order to perform a non-systematic narrative review in reference to a case report.
Results: Overall, 31 articles were selected for an update of the topic proposed, and a case report was described.
Conclusions: The use of epidural infusions in patients with herpes zoster is a treatment option for acute pain; it favors passive motion of the affected limb preventing atrophy, helps prevent post-herpetic neuralgia, is available in our setting, and has a low incidence of complications.
References
1. Watson P. Postherpetic neuralgia. Am Fam Physician. 2011;84:690-2.
2. Drolet M, Brisson M, Schmader KE, Levin MJ, Johnson R, Oxman MN, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life:A prospective study. CMAJ. 2010;182:1731-6.
3. Watson P. Herpes zoster and postherpetic neuralgia. CMAJ. 2010;182:1713-4.
4. Thyregod HG, Rowbotham MC, Peters M, Possehn J, Berro M, Petersen KL. Natural history of pain following herpes zoster. Pain. 2007;128:148-56.
5. Christo PJ, Hobelmann G, Maine DN. Post-herpetic neuralgia in older adults: Evidence-based approaches to clinical management. Drugs Aging. 2007;24:1-19.
6. Bennett GJ, Watson PN. Herpes zoster and postherpetic neuralgia: Past, present and future. Pain Res Manage. 2009;14:275-82.
7. Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61:2437-44, 2437-2448.
8. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: Results from a population-based survey. J Pain. 2005;6:356-63.
9. Schmader K, Gnann Jr JW, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. J Infect Dis. 2008;197 Suppl 2:S207-15.
10. Philip A, Thakur R. Post herpetic neuralgia. J Palliat Med. 2011;14:765-73.
11. Morlion B. Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Curr Med Res Opin. 2011;27:11-33.
12. Mercadante S, Bruera E. The effect of age on opioid switching to methadone: A systematic review. J Palliat Med. 2012;15:347-51.
13. Bowsher D. The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: A randomized, double-blind, placebo-controlled trial. J Pain Symptom Manage. 1997;13:327-31.
14. Bowsher D. Factors influencing the features of postherpetic neuralgia and outcome when treated with tricyclics. Eur J Pain. 2003;7:1-7.
15. Zin Ch, Nissen LM, Smith MT, O'Callaghan JP, Moor BJ. An update on the pharmacological management of post-herpetic neuralgia and painful diabetic neuropathy. CNS Drugs. 2008;22:417-42.
16. Kumar V, Krone K, Mathieu A. Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: An appraisal of current evidence. Reg Anesth Pain Med. 2004;29:454-61.
17. Van Wijck AJ, Opstelten W, Moons KG, van Essen GA,Stolker RJ, Kalkman CJ, et al. The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: A randomised controlled trial. Lancet. 2006;367:219-24.
18. Cluff R, Mehio AK, Cohen SP, Chang Y, Sang CN, Stojanovic MP. The technical aspects of epidural steroid injections: A national survey. Anesth Analg. 2002;95:403-8.
19. Ward A, Watson J, Wood P, Dunne C, Kerr D. Glucocorticoid epidural for sciatica: Metabolic and endocrine sequelae. Rheumatol Oxf. 2002;41:68-71.
20. Owlia MB, Salimzadeh A, Alishiri GH, Haghighi A. Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain. Singapore Med J. 2007;48:241-5.
21. Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections. Spine. 2002;27:509-14.
22. Kim KS, Shin SS, Kim TS, Jeong CY, Yoon MH, Choi JI. Fluoroscopically guided cervical interlaminar epidural injections using the midline approach: an analysis of epidurography contrast patterns. International Anesthesia Research Society. 2009;108:1658-61.
23. el-Khoury GY, Ehara S, Weinstein JN, Montgomery WJ,Kathol MH. Epidural steroid injection: A procedure ideally performed with fluoroscopic control. Radiology. 1998;168:554-7.
24. Elkersh MA, Simopoulos TT, Malik AB, Cho EH, Bajwa ZH. Epidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain. Reg Anesth Pain Med. 2003;28:344-6.
25. Kishimoto N, Kato J, Suzuki T, Arakawa H, Ogawa S, Suzuki H. A case of RSD with complete disappearance of symptoms following intravenous ketamine infusion combined with stellate ganglion block and continuous epidural block. Masui. 1995;44:1680-4.
26. Mizuno J, Sugimoto S, Ikeda M, Ikeda M, Machida K, Mikawa Y. Usefulness of epidural administration of ketamine for relief of postherpetic neuralgia. Masui. 2001;50:904-7.
27. Manabe H, Dan K, Hirata K, Hori K, Shono S, Tateshi S, et al. Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain. Clin J Pain. 2004;20:302-30.
28. Cid J, de Andrés J, Reig E, del Pozo C, Cortés A, García-Cruz JJ. Cervicalgias y lumbalgias mecanicodegenerativas. Tratamiento conservador. Rev Soc Esp Dolor. 2001;8 Supl II:79-100.
29. Lin T, Wong C, Chen F, Lin S, Ho S. Long-term epidural ketamine, morphine and bupivacaine attenuate reflex sympathetic dystrophy neuralgia. Can J Anaesth. 1998;45:175-7.
30. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al., Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271-84.
31. Zostavax. Whitehouse Station, NJ: Merck & Co Inc; December 2008. Available at: http://www.merck.com/product/usa/pi circulars/z/zostavaxpi.pdf
2. Drolet M, Brisson M, Schmader KE, Levin MJ, Johnson R, Oxman MN, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life:A prospective study. CMAJ. 2010;182:1731-6.
3. Watson P. Herpes zoster and postherpetic neuralgia. CMAJ. 2010;182:1713-4.
4. Thyregod HG, Rowbotham MC, Peters M, Possehn J, Berro M, Petersen KL. Natural history of pain following herpes zoster. Pain. 2007;128:148-56.
5. Christo PJ, Hobelmann G, Maine DN. Post-herpetic neuralgia in older adults: Evidence-based approaches to clinical management. Drugs Aging. 2007;24:1-19.
6. Bennett GJ, Watson PN. Herpes zoster and postherpetic neuralgia: Past, present and future. Pain Res Manage. 2009;14:275-82.
7. Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61:2437-44, 2437-2448.
8. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD. Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: Results from a population-based survey. J Pain. 2005;6:356-63.
9. Schmader K, Gnann Jr JW, Watson CP. The epidemiological, clinical, and pathological rationale for the herpes zoster vaccine. J Infect Dis. 2008;197 Suppl 2:S207-15.
10. Philip A, Thakur R. Post herpetic neuralgia. J Palliat Med. 2011;14:765-73.
11. Morlion B. Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Curr Med Res Opin. 2011;27:11-33.
12. Mercadante S, Bruera E. The effect of age on opioid switching to methadone: A systematic review. J Palliat Med. 2012;15:347-51.
13. Bowsher D. The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: A randomized, double-blind, placebo-controlled trial. J Pain Symptom Manage. 1997;13:327-31.
14. Bowsher D. Factors influencing the features of postherpetic neuralgia and outcome when treated with tricyclics. Eur J Pain. 2003;7:1-7.
15. Zin Ch, Nissen LM, Smith MT, O'Callaghan JP, Moor BJ. An update on the pharmacological management of post-herpetic neuralgia and painful diabetic neuropathy. CNS Drugs. 2008;22:417-42.
16. Kumar V, Krone K, Mathieu A. Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: An appraisal of current evidence. Reg Anesth Pain Med. 2004;29:454-61.
17. Van Wijck AJ, Opstelten W, Moons KG, van Essen GA,Stolker RJ, Kalkman CJ, et al. The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: A randomised controlled trial. Lancet. 2006;367:219-24.
18. Cluff R, Mehio AK, Cohen SP, Chang Y, Sang CN, Stojanovic MP. The technical aspects of epidural steroid injections: A national survey. Anesth Analg. 2002;95:403-8.
19. Ward A, Watson J, Wood P, Dunne C, Kerr D. Glucocorticoid epidural for sciatica: Metabolic and endocrine sequelae. Rheumatol Oxf. 2002;41:68-71.
20. Owlia MB, Salimzadeh A, Alishiri GH, Haghighi A. Comparison of two doses of corticosteroid in epidural steroid injection for lumbar radicular pain. Singapore Med J. 2007;48:241-5.
21. Stojanovic MP, Vu TN, Caneris O, Slezak J, Cohen SP, Sang CN. The role of fluoroscopy in cervical epidural steroid injections. Spine. 2002;27:509-14.
22. Kim KS, Shin SS, Kim TS, Jeong CY, Yoon MH, Choi JI. Fluoroscopically guided cervical interlaminar epidural injections using the midline approach: an analysis of epidurography contrast patterns. International Anesthesia Research Society. 2009;108:1658-61.
23. el-Khoury GY, Ehara S, Weinstein JN, Montgomery WJ,Kathol MH. Epidural steroid injection: A procedure ideally performed with fluoroscopic control. Radiology. 1998;168:554-7.
24. Elkersh MA, Simopoulos TT, Malik AB, Cho EH, Bajwa ZH. Epidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain. Reg Anesth Pain Med. 2003;28:344-6.
25. Kishimoto N, Kato J, Suzuki T, Arakawa H, Ogawa S, Suzuki H. A case of RSD with complete disappearance of symptoms following intravenous ketamine infusion combined with stellate ganglion block and continuous epidural block. Masui. 1995;44:1680-4.
26. Mizuno J, Sugimoto S, Ikeda M, Ikeda M, Machida K, Mikawa Y. Usefulness of epidural administration of ketamine for relief of postherpetic neuralgia. Masui. 2001;50:904-7.
27. Manabe H, Dan K, Hirata K, Hori K, Shono S, Tateshi S, et al. Optimum pain relief with continuous epidural infusion of local anesthetics shortens the duration of zoster-associated pain. Clin J Pain. 2004;20:302-30.
28. Cid J, de Andrés J, Reig E, del Pozo C, Cortés A, García-Cruz JJ. Cervicalgias y lumbalgias mecanicodegenerativas. Tratamiento conservador. Rev Soc Esp Dolor. 2001;8 Supl II:79-100.
29. Lin T, Wong C, Chen F, Lin S, Ho S. Long-term epidural ketamine, morphine and bupivacaine attenuate reflex sympathetic dystrophy neuralgia. Can J Anaesth. 1998;45:175-7.
30. Oxman MN, Levin MJ, Johnson GR, Schmader KE, Straus SE, Gelb LD, et al., Shingles Prevention Study Group. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271-84.
31. Zostavax. Whitehouse Station, NJ: Merck & Co Inc; December 2008. Available at: http://www.merck.com/product/usa/pi circulars/z/zostavaxpi.pdf
How to Cite
1.
Rivera Díaz RC, Arcila Lotero MA. Cervical epidural infusion for the treatment of herpes zoster pain. Case report with review of the literature. Colomb. J. Anesthesiol. [Internet]. 2013 Oct. 1 [cited 2024 Apr. 20];41(4):291-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/672
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Published
2013-10-01
How to Cite
1.
Rivera Díaz RC, Arcila Lotero MA. Cervical epidural infusion for the treatment of herpes zoster pain. Case report with review of the literature. Colomb. J. Anesthesiol. [Internet]. 2013 Oct. 1 [cited 2024 Apr. 20];41(4):291-7. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/672
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Case Report / Case Series
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