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Neurology


 

 




Postherpetic Neuralgia

    

  • Naoki Kotani, Tetsuya Kushikata, et al

    Intrathecal methylprednisolone for intractable postherpetic neuralgia

    New Eng J Med. 343Nov.23, 2000, 1514-1519

        

    There is no effective treatment for postherpetic neuralgia. As there is evidence that there is an inflammatory component in this disorder, the authors have assessed treatment with intrathecally. administered methylprednisolone to reduce pain.

       

    Study was carried out in 277 patients. They received (random assignment) intrathecal methylprednisolone (60mg) and lidocaine (3ml 3 %), lidocaine alone or no treatment. Injection was once a week for upto 4 weeks and follow up was upto 2 years.

       

    There was minimal change in the degree of pain in the lidocaine only and control group. In the methylprednisolone + lidocaine group, intensity and area of pain decreased and use of diclofenac decreased.

       

    In patients who received methylprednisolone, interleukin-8 concentrations decreased by 50% and this decrease correlated with the duration of neuralgia and with extent of relief of pain. Intrathecal methylprednisolone appears to be an effective treatment for postherpetic neuralgia.

       

    EDITORIAL

    A New Treatment for Postherpetic Neuralgia

       

    Randomized controlled trials have supported the use of older antidepressants – such as amitryptyline, nortryptiline, but nearly 50% patients either do not respond or have intolerable adverse effects. Recent trials
    of methylprednisolone + lidocaine have supported the use of the anticonvulsant -gabapentin, (fewer side effects), opioid oxycodone and a lidocaine skin patch

        

    Currently, lidocaine skin patch may be used at the start, if no relief, use nortryptyline (fewer side effects) at a low dose of 10-20 mg/day, with gradual increase in dosage. Alternatively, gabapentin may be used starting with a low dose and upto a maximum of 3500mg/day. Opioids can be used in refractory cases.

        

    However, none of these approaches are fully satisfactory. In the study by Kotani et al during the 2 yrs of trial no critical adverse effects, such as arachnoiditis or neurotoxic effects from methylprednisolone were noted. However, use of this technique in larger number of patients and observation during longer follow up periods will be needed to identify potentially severe adverse effects. This study does not address the problem of postherpetic neuralgia involving the trigeminal nerve.

        

 



 

 

Speciality Spotlight

 

 
Neurology
 

 

Postherpetic Neuralgia
    

  • Naoki Kotani, Tetsuya Kushikata, et al
    Intrathecal methylprednisolone for intractable postherpetic neuralgia
    New Eng J Med. 343Nov.23, 2000, 1514-1519
        
    There is no effective treatment for postherpetic neuralgia. As there is evidence that there is an inflammatory component in this disorder, the authors have assessed treatment with intrathecally. administered methylprednisolone to reduce pain.
       
    Study was carried out in 277 patients. They received (random assignment) intrathecal methylprednisolone (60mg) and lidocaine (3ml 3 %), lidocaine alone or no treatment. Injection was once a week for upto 4 weeks and follow up was upto 2 years.
       
    There was minimal change in the degree of pain in the lidocaine only and control group. In the methylprednisolone + lidocaine group, intensity and area of pain decreased and use of diclofenac decreased.
       
    In patients who received methylprednisolone, interleukin-8 concentrations decreased by 50% and this decrease correlated with the duration of neuralgia and with extent of relief of pain. Intrathecal methylprednisolone appears to be an effective treatment for postherpetic neuralgia.
       
    EDITORIAL
    A New Treatment for Postherpetic Neuralgia
       
    Randomized controlled trials have supported the use of older antidepressants – such as amitryptyline, nortryptiline, but nearly 50% patients either do not respond or have intolerable adverse effects. Recent trials of methylprednisolone + lidocaine have supported the use of the anticonvulsant -gabapentin, (fewer side effects), opioid oxycodone and a lidocaine skin patch
        
    Currently, lidocaine skin patch may be used at the start, if no relief, use nortryptyline (fewer side effects) at a low dose of 10-20 mg/day, with gradual increase in dosage. Alternatively, gabapentin may be used starting with a low dose and upto a maximum of 3500mg/day. Opioids can be used in refractory cases.
        
    However, none of these approaches are fully satisfactory. In the study by Kotani et al during the 2 yrs of trial no critical adverse effects, such as arachnoiditis or neurotoxic effects from methylprednisolone were noted. However, use of this technique in larger number of patients and observation during longer follow up periods will be needed to identify potentially severe adverse effects. This study does not address the problem of postherpetic neuralgia involving the trigeminal nerve.
        

 

 

By |2022-07-20T16:44:14+00:00July 20, 2022|Uncategorized|Comments Off on Postherpetic Neuralgia

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