What Are the Different Types of Postherpetic Neuralgia Treatment?

Shingles is an acute skin disease caused by varicella-zoster virus. Children who are not immune to this virus develop chickenpox, and some people do not appear chickenpox after infection. It is a recessive infection and becomes a virus. By. This virus is neurotropic, and after invading the sensory nerve endings of the skin, it can move along the nerve to the ganglia of the posterior root of the spinal cord and lurk there. When the host's cellular immune function is low, such as colds, fever, In systemic lupus erythematosus and malignant tumors, the virus is excited again, causing ganglion inflammation and necrosis. At the same time, the reactivated virus can move along the peripheral nerve fibers to the skin to develop herpes with pain; the older the nerve pain weight. If the virus in the body and the virus that senses the peripheral nerves are cleared in vitro, there will be no sequelae. Otherwise, sequelae may be formed.

Basic Information

English name

postherpetic neuralgia

Visiting department

Neurology, pain, dermatology

Multiple groups

People over 60

Common locations

Distribution area of thoracic intercostal nerve and facial trigeminal nerve

Common causes

Related to old age, herpes attack area, acute attack pain, severe organic disease before and after shingles

Common symptoms

Local paroxysmal or persistent burning, tingling, jumping pain, stabbing pain

Causes of postherpetic neuralgia

Shingles is a skin symptom that causes neuroinflammation after recurrent episodes of herpes type 1 virus. It is a symptom; and the invasion of nerves by the intrinsic virus is the root cause and the cause of neuralgia. The factors that are easy to leave herpes with severe neuralgia are:

1. Age factor. Patients older than 60 years of age should consult a pain department in time if shingles occurs. The reason why age is the most important factor is that postherpetic neuralgia is closely related to age. The root cause is the problem of low immunity. The older you are, the worse your immunity is. Once herpes occurs, the virus affects the nerves. The harder the damage is, the more difficult it is to repair itself, the greater the probability of sequelae, the heavier the pain, and the longer the duration;

2. The size of the herpes attack area, the postherpetic neuralgia is positively related to the herpes attack area. The larger the area, the easier it is to crust and form scar tissue.

3. The acute herpes episode is accompanied by severe neuropathic pain. During the acute herpes episode, there is obvious neuralgia, including paroxysmal acute pain, persistent burning-like acupuncture-like pain. After the herpes is cured, the more likely it is to have severe neuropathic pain, which requires early intervention;

In the early stage of acute herpes, no adequate antiviral treatment was given. Early sufficient antiviral treatment can limit the damage of herpes type I virus to the nerves and significantly reduce the occurrence of postherpetic neuralgia;

4. Before and after the occurrence of shingles, patients with severe organic diseases, such as cardiovascular and cerebrovascular diseases, malignant tumors, and uremia patients, have a significantly increased probability of postherpetic neuralgia. These patients need either surgery or systemic chemotherapy or local radiotherapy, and patients with uremia need continuous immunosuppression after kidney transplantation. The systemic immunity continues to decline significantly, which can easily lead to herpes attacks and the virus to the nerves. It has great destructive power, almost self-healing ability is lost, and the probability of occurrence of neuralgia is extremely high;

5. Patients with systemic fever and other symptoms at the onset of herpes have a higher probability of neuralgia.

Clinical manifestations of postherpetic neuralgia

Overall symptoms

Occurred after herpes zoster virus infection, 10% of patients have pain for more than one month. Without timely treatment or improper treatment, the pain can still exist after the herpes disappears, and in some cases the pain even exceeds decades. It is related to the age of onset, and it rarely occurs in patients younger than 40 years old. The incidence rate is 50% in patients over 60 years old, 75% in patients over 70 years old, and about 10% to 25% of patients with sequel neuralgia can sustain pain. One year. Can occur before or with the rash.

2. Occurrence area

(1) The rash is mostly distributed along a peripheral nerve: intercostal nerve (53%): most common, often involving 2 to 3 intercostal nerve distribution areas, the rash extends from the back to the front and downward, consistent with the nerve distribution area , Generally not midline; severe pain before the rash, exactly like pleurisy or myocardial infarction. Trigeminal nerve (15%). Cervical nerves (20%) and lumbosacral nerves (11%) occurred.

(2) Herpes zoster-free: This disease does not appear herpes, but has typical local peripheral neuralgia. Intercostal neuralgia is more common. Neuralgia and paralysis can also occur in the area of the brain nerve distribution. The course can be prolonged. 2 week.

Postherpetic neuralgia examination

1. Blood routine, urine routine, stool routine.

2. Screening of liver and kidney function, electrolytes, blood glucose, blood lipids, immunoglobulins, and infectious diseases (hepatitis B, hepatitis C, AIDS, syphilis, etc.).

3.X-ray chest radiograph and electrocardiogram.

4. Items selected according to the patient's condition: tumor-related screening: tumor antigens and markers, choice of B-ultrasound, CT, MRI, barium meal or endoscopy of the digestive tract; bacterial culture and drug sensitivity tests on wounds

Diagnosis of postherpetic neuralgia

It can be diagnosed based on clinical symptoms, rash characteristics, and test results.

Treatment of postherpetic neuralgia

Neuralgia treatment

(1) Corticosteroids

Prednisone is administered orally at a dose of 30mg / day, and it is gradually reduced after it is obviously effective (about 7 to 10 days). Generally, a good effect can be obtained.

(2) Local blocking treatment of triamcinolone suspension

1ml (10mg) of triamcinolone suspension plus 0.5 ~ 1% procaine or lidocaine injection 4 ~ 8ml injected subcutaneously into the affected nerve, once a week, such as intercostal nerve, can also be injected into the spine The intercostal space between the affected nerves is 3 to 4 cm.

2. Antiviral treatment

(1) Antiviral drugs should be applied as soon as possible. The commonly used drug acyclovir is taken orally, and those with impaired renal function need to be reduced.

(2) Analgesics commonly used: analgesics, 1 tablet. Carbamazepine is 0.1g each tablet. At first, take half a tablet at a time, and gradually increase it to 3 times a day, 1 tablet each time. The analgesic effect is obvious. However, attention should be paid to leukopenia and thrombocytopenia, rash, liver and kidney function changes, etc., history of atrioventricular block and history of bone marrow suppression are contraindicated.

(3) Vitamin B1 is commonly used orally for nutritional and neurological medicines; vitamin B _{12 is} injected intramuscularly.

3. physical therapy

(1) Ultraviolet rays: irradiate the skin lesions with medium-wave ultraviolet rays (UVB) to promote the skin to dry up and crust.

(2) Infrared or ultra-short wave: Irradiate the affected area and help relieve pain.

4. Chinese medicine treatment

Oral Chinese medicine with plum blossom needles, fire needles, cupping, and bloodletting therapy.

Precautions for postherpetic neuralgia

1. The purpose of early and accurate syndrome differentiation treatment is to expel the disease as soon as possible and reduce the stimulus and damage to the body.

2. Pay attention to rest, take medicine and rub the medicine carefully, do not eat spicy foods such as seafood, eggs, fish, beef and mutton, and stir-fry food during the medication. It should be light, eat more fruits and vegetables, supplement Vitamins.

3. Elderly and fragile patients should prevent their serious complications: Most of the elderly suffer from the decline of the body's function, and their immune function is low. Under the influence of related causes, they are prone to shingles, and it is easy to occur after the illness. Serious complications, frail people, especially patients who have long-term use of corticosteroids, so it is very important to prevent the occurrence of serious complications.