ID:16554 Differential Targeted Multiplexed SCS Improves Quality of Life in Patients With Painful Postherpetic Neuralgia

Abstract

Postherpetic neuralgia (PHN) is a painful neuropathic condition that persists after infection with the Herpes Zoster Virus (HZV). Patients with PHN experience allodynia and severe pain in the affected dermatomal distribution. Mechanisms surrounding PHN are complex although they are thought to involve peripheral nerve injury and altered signal processing of the central nervous system resulting in overall central sensitization.1 Once the viral infection has resolved, patients with persistent pain trial tricyclic antidepressants, gabapentinoids, transcutaneous electrical nerve stimulation (TENS), and topical lidocaine.1 PHN is oftentimes resistant to these first line therapies. Patients then may escalate to topical 8% capsaicin treatment or more invasive therapies, though refractory patients are typically relegated to opioids. While some pursue advanced neurosurgical therapies, primarily spinal cord stimulation (SCS) and dorsal root ganglion stimulation (DRG-S), most patients don’t have appetite for these therapies. A primary difficulty with SCS for these patients is identifying appropriate stimulation settings that adequately manages their neuropathic pain.2