Abstract
BackgroundContinuous epidural infusions are commonly used in clinical settings to reduce the likelihood of transition to postherpetic neuralgia via pain control. The purpose of this study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion in which the catheter is guided by electric stimulation to areas with neurological damage for the treatment of zoster-related pain and prevention of postherpetic neuralgia.MethodsWe analyzed the medical records of 114 patients in this study. The patients were divided into two groups: contrast (conventional continuous epidural infusion) and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure.ResultsAfter adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. After adjustment, the odds of complete remission were 1.9-times higher in the stimulation group than in the contrast group (95% confidence interval [CI]: 0.81–4.44, P = 0.14). Patients in the contrast group were significantly more likely to require other interventions within 6 months of the procedure than patients in the stimulation group (odds ratio: 3.62, 95% CI: 1.17–11.19, P = 0.03).ConclusionEpidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in the acute phase of herpes zoster.
Highlights
Continuous epidural infusions are commonly used in clinical settings to reduce the likelihood of transition to postherpetic neuralgia via pain control
The patients were divided into two groups depending on the type of epidural catheter used for continuous epidural infusion: the contrast group, which used standard epidural catheters, and the stimulation group, which used epidural catheters with electric stimulation
The odds of complete remission of herpes zoster up to 6 months after the procedure was 1.9times higher in the stimulation group than in the contrast group. This suggests that administering the drug after confirming the correct varicella zoster virus (VZV)-containing dorsal root ganglion using epidural electric stimulation may be more effective in treating herpes zoster than the conventional continuous epidural infusion
Summary
Continuous epidural infusions are commonly used in clinical settings to reduce the likelihood of transition to postherpetic neuralgia via pain control. Herpes zoster is caused by reactivation of the latent varicella zoster virus (VZV), which persists in the dorsal root ganglion after the initial infection. It causes irritation along the nerve distribution, abnormal sensitization of nociceptive receptors, and induces hyperactivity of the central nerve [1]. Postherpetic neuralgia (PHN) is the most common complication of herpes zoster and can occur if the patient is not properly treated during the acute phase; in elderly patients, it can be due to a weakened immune system, despite proper treatment [5]. Patients at risk of developing PHN may require aggressive treatment using appropriate drug therapies
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