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Title: Multimodal Treatment For Postherpetic Neuralgia With Novel Perspective Of Neuralgia As Neuromyalgia
e-poster Number: INSIM111
Category: Pain
Author Name: Khyati Ramesh Patel
Institute: Ashirvad Institute for Pain Management and Research
Co-Author Name: Lakshmi Vas, Ankush Wasnik, Jhanvi Vora
Abstract :
Introduction:
Postherpetic neuralgia is a chronic painful condition as a consequence of nerve damage after herpes zoster infection. This severe pain can lead to anxiety, depression and even suicidal ideation thus impacting quality of life .
Case report:
We report a case of 28 year old urologist suffering from post herpetic neuralgia since 4 years. He had continuous burning, sharp pain (NRS:3-4) over left shoulder, upper arm, forearm, dorsum of hand, anterior chest wall, back of neck, pre auricular area, angle of mandible with intermittent exacerbation (NRS : 8-9) 6-8 episodes/day. He was taking T.GabapinNT 100 mg bd and had tried multiple drugs without any relief.
We addressed neuropathy by PRF of suprascapular, Lateral and medial pectoral ,musculocutaneous, axillary, dorsal scapular, spinal accessory nerve at 42 degrees for 10 min located under USG guidance. Patient reported around 40% pain relief at 2 week. And for myopathy component, we injected total 150 units of Botulinum toxin-A in multiple divided doses into muscles of his burning pain regions. Post Botox, he was painfree throughout the day with intermittent exacerbation to NRS 2-3 towards end of day . He had complete resolution of pain from ear, chest wall, face but some intermittent pain persisted in left arm and forearm which was treated by USG guided dry needling. He was pain free after 6 such sessions performed over subsequent month.
Conclusion:
PHN is not only neuropathy but neuromyopathic condition. Complete pain relief is possible when both nerve and muscle components are treated.
