Background: Postherpetic neuralgia, a persistent pain condition often characterized by allodynia
and hyperalgesia, is a deleterious consequence experienced by patients after an acute herpes
zoster vesicular eruption has healed. The pain associated with postherpetic neuralgia can severely
affect a patient’s quality of life, quality of sleep, and ability to participate in activities of daily living.
Currently, first-line treatments for this condition include the administration of medication therapies
such as tricyclic antidepressants, pregabalin, gabapentin, and lidocaine patches, followed by the
application of tramadol and capsaicin creams and patches as second- or third-line therapies. As not
all patients respond to such conservative options, however, interventional therapies are valuable
for those who continue to experience pain.
Objective: This review focuses on interventional therapies that have been subjected to
randomized controlled trials for the treatment of postherpetic neuralgia, including transcutaneous
electrical nerve stimulation; local botulinum toxin A, cobalamin, and triamcinolone injection;
intrathecal methylprednisolone and midazolam injection; stellate ganglion block; dorsal root
ganglion destruction; and pulsed radiofrequency therapy.
Study Design: Systematic review
Setting: Hospital department in Taiwan
Methods: Search of PubMed database for all randomized controlled trials regarding postherpetic
neuralgia that were published before the end of May 2017.
Results: The current evidence is insufficient for determining the single best interventional
treatment. Considering invasiveness, price, and safety, the subcutaneous injection of botulinum
toxin A or triamcinolone, transcutaneous electrical nerve stimulation, peripheral nerve stimulation,
and stellate ganglion block are recommended first, followed by paravertebral block and pulsed
radiofrequency. If severe pain persists, spinal cord stimulation could be considered. Given the
destructiveness of dorsal root ganglion and adverse events of intrathecal methylprednisolone
injection, these interventions should be carried out with great care and only following
comprehensive discussion.
Limitations: Although few adverse effects were reported, these procedures are invasive, and a
careful assessment of the risk-benefit ratio should be conducted prior to administration.
Conclusion: With the exception of intrathecal methylprednisolone injection for postherpetic
neuralgia, the evidence for most interventional procedures used to treat postherpetic neuralgia is
Level 2, according to “The Oxford Levels of Evidence 2”. Therefore, these modalities have received
only grade B recommendations. Despite the lack of a high level of evidence, spinal cord stimulation
and peripheral nerve stimulation are possibly useful for the treatment of postherpetic neuralgia.
Key words: Interventional treatment, postherpetic neuralgia, botulinum toxin, steroid, stellate
ganglion block, peripheral nerve stimulation, paravertebral block, radiofrequency, spinal cord
stimulation
Peripheral Nerve Stimulation of the Lateral Femoral Cutaneous and Superior Gluteal Nerves for Treating Proximal Neuropathy Hip Pain
