Más sobre NPH/More on PHN

Diagnóstico y tratamiento de la neuralgia postherpética


Diagnosing and managing postherpetic neuralgia.
Nalamachu S, Morley-Forster P.
International Clinical Research Institute, Inc., Overland Park, KS 66210, USA. nalamachu@yahoo.com
Drugs Aging. 2012 Nov;29(11):863-9. doi: 10.1007/s40266-012-0014-3.
Abstract
Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. Varicella zoster infection is almost universally prevalent, making prevention of acute herpes zoster (AHZ) infection and prompt diagnosis and aggressive management of PHN of critical importance. Despite the recent development of a herpes zoster vaccine, prevention of AHZ is not yet widespread or discussed in PHN treatment guidelines. Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. PHN pain is typically localized, unilateral and chronic, but may be constant, intermittent, spontaneous and/or evoked. PHN is likely to interfere with sleep and daily activities. First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. Tricyclic antidepressants, gabapentinoids and strong opioids are effective but are also associated with systemic adverse events that may limit their use in many patients, most notably those with significant medical comorbidities or advanced age. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Given the low systemic drug exposure, adverse events with topical therapies are generally limited to application-site reactions, which are typically mild and transient with lidocaine 5 % patch, but may involve treatment-limiting discomfort with capsaicin cream or 8 % patch. Based on available clinical data, clinicians should consider administering the herpes zoster vaccine to all patients aged 60 years and older. Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693437/pdf/40266_2012_Article_14.pdf


Bloqueo del nervio infraorbitario con radiofrecuencia de pulso guiado con ultrasonido para el tratamiento de neuralgia postherpética intratable. Informe de caso

Ultrasound-guided infraorbital nerve pulsed radiofrequency treatment for intractable postherpetic neuralgia - a case report.
Lim SM, Park HL, Moon HY, Kang KH, Kang H, Baek CH, Jung YH, Kim JY, Koo GH, Shin HY.
Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Korea.
Korean J Pain. 2013 Jan;26(1):84-8. doi: 10.3344/kjp.2013.26.1.84. Epub 2013 Jan 4.
Abstract
A 60-year-old man presented with pain on the left cheek and lateral nose. The patient had been diagnosed with facial herpes zoster in the left V2 area 6 months previously. Medical treatment was prescribed for 6 months but it had little effect. We blocked the left infraorbital nerve under ultrasound guidance, but pain relief was short term. Therefore, we performed pulsed radiofrequency treatment on the left infraorbital nerve under ultrasound guidance. Six months after the procedure, the reduction of pain was still maintained, and there was no need for further management.
KEYWORDS: infraorbital nerve, radiofrequency, ultrasound




http://pdf.medrang.co.kr/paper/pdf/Jkp/Jkp026-01-16.pdf



Tratamiento y prevención del herpes zoster: perspectiva canadiense
Management and prevention of herpes zoster: A Canadian perspective.
Boivin G, Jovey R, Elliott CT, Patrick DM.
Research Centre in Infectious Diseases of the Centre Hospitalier Universitaire de Québec and Laval University, Quebec City, Quebec;
Can J Infect Dis Med Microbiol. 2010 Spring;21(1):45-52.
Abstract
Varicella-zoster virus reactivation leads to herpes zoster - the main complication of which is postherpetic neuralgia (PHN). Rapid antiviral therapy initiated within 72 h of rash onset has been shown to accelerate rash healing, reduce the duration of acute pain and, to some extent, attenuate the development and duration of PHN. Other adjunctive therapies such as analgesics, antidepressants and some anticonvulsants are frequently required in the management of severe PHN. A live, attenuated zoster vaccine has been recently shown to significantly decrease herpes zoster incidence, PHN and the overall burden of illness when administered to adults older than 60 years of age. This new prophylactic modality has been reported to be cost-effective in the Canadian context, especially in the 60- to 75-year-old age group.
KEYWORDS: Antivirals, Postherpetic pain, Prevention, Vaccine, Zoster

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852282/pdf/idmm21045.pdf




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Anestesiología y Medicina del Dolor
www.anestesia-dolor.org