1/6. Gabapentin-induced neurologic toxicities. Gabapentin is an antiepileptic drug approved for the treatment of postherpetic neuralgia and as adjunctive therapy for partial seizures. The drug has been shown to be safe and nontoxic. The current literature has limited reports of neurologic toxicity associated with gabapentin therapy in patients with or without renal dysfunction. We describe the case of a 75-year-old man with renal dysfunction who developed neurologic toxicity due to gabapentin accumulation. Future studies are warranted to confirm the neurologic adverse effects of gabapentin, including any additional risks in patients with renal dysfunction. ( info) |
2/6. Repetitive paravertebral nerve block using a catheter technique for pain relief in post-herpetic neuralgia. We described in this report a case of post-herpetic neuralgia refractory to medical therapy that was successfully treated with repetitive injections of local aesthetic mixture (bupivacaine 0.5% 19 ml and clonidine 150 microg ml(-1) 1 ml) every 48 h for 3 weeks using a paravertebral catheter inserted at T2-T3 level. ( info) |
3/6. Postherpetic pain: more than sensory neuralgia? OBJECTIVE: To describe a series of older adult patients with postherpetic myofascial pain, a heretofore rarely described complication of herpes zoster. DESIGN: Case series. SETTING: Outpatient older adult pain clinic. patients: Five older adults are presented with myofascial pain that developed as a complication of herpes zoster. RESULTS: Pain duration at the time of presentation ranged from 4 months to 7 years. All patients reported functional impairment from pain despite oral analgesics. Myofascial pathology was diagnosed by the presence of taut bands and trigger points in the affected myotome. Upon successful treatment of the myofascial pain with nonpharmacologic modalities (e.g., physical therapy, trigger point injections, dry needling, and/or percutaneous electrical nerve stimulation), all patients reported symptomatic improvement, and four out of five were able to significantly reduce or discontinue their opioids. CONCLUSION: Postherpetic pain is traditionally conceptualized as a purely sensory phenomenon. Identification of the intrusion of a myofascial component may be worthwhile, both from the standpoint of enhanced pain relief and reduction in the need for oral analgesics. Formal exploration of this phenomenon is needed. ( info) |
4/6. Development of bilateral herpes zoster following thoracoscopic splanchnicectomy. A 39-year-old female presented for elective bilateral thoracoscopic splanchnicectomy for chronic severe visceral pain. Surgery and anaesthesia were uneventful and she gained good symptomatic relief. Postoperative recovery was complicated by the development on day four of bilateral herpes zoster at the T8 dermatome level. This was treated immediately with oral acyclovir. She subsequently developed severe post-herpetic neuralgia requiring the recommencement of gabapentin and amitriptyline. Further benefit was gained from a course of calcitonin. This case report examines the possible causative factors in the development of post-surgical herpes zoster. ( info) |
| A 78-year-old man with severe chronic obstructive pulmonary disease presented to our pain medicine clinic for treatment of post herpetic neuralgia. Pharmacotherapy with tricyclic antidepressants, anticonvulsants, tramadol and traditional analgesics had failed, primarily due to adverse drug effects, particularly sedation, dizziness and nausea. Consequently, intravenous salmon calcitonin was administered, based on evidence of efficacy in the treatment of other neuropathic pain syndromes and its relatively benign side-effects profile. The patient reported immediate and sustained improvement in his post herpetic neuralgia for over two months, without adverse effects from the calcitonin therapy. ( info) |
6/6. interleukin-2: a potential treatment option for postherpetic neuralgia? Postherpetic neuralgia is a chronic pain syndrome that is often difficult to treat and can lead to a disabling disease if it is resistant to therapy. Presented here is the case of a 46-year-old patient with human immunodeficiency virus infection and chronic, treatment-resistant neuralgia. Postherpetic pain resolved after treatment with 1 cycle of subcutaneous recombinant interleukin-2. ( info) |