Abstract
Thirty-seven patients with long-standing post-herpetic neuralgia and 27 with post-traumatic neuralgia (PTN) were treated with three epidural injections each of methylprednisolone acetate (Depo Medrol) given at weekly intervals. Differential subarachnoid or epidural block was done in all patients and placebo responders were excluded from the study. Mean age, duration of symptoms, and pain intensity measured by visual analogue scale were similar in both groups. Visual analogue scale ratings were reduced one month after treatments from pretreatment values of 84.4 and 78.7 to 9.6 and 15.2 in the post-herpetic and post-traumatic groups respectively, and were further reduced to 4.6 and 11.6 respectively after one year when 89 per cent of patients in the post-herpetic group and 59 per cent of patients in the posttraumatic group were completely pain free. Side effects were minor in all cases. It is suggested that this is the treatment of choice in post-herpetic and post-traumatic neuralgia where steroid administration is not contraindicated.
Résumé
Trente-sept patients souffrant de névralgie post-herpétique de longue durée et vingt-sept de névralgie post-traumatique ont été traités avec trois injections épidurale chacun ďacétate de méthyl prednisolone administrées à une semaine ďintervalle. Un bloquage différentiel sousarachnoidien ou épidural fut effectué ďabord chez tous ces malades et ceux qui étaient soulagés par le placebo ont été exclus de ľétude. Ľâge moyen, la durée des symptômes et ľintensité à la douleur mesurée par représentation graphique étaient identiques dans les deux groupes. La cote ďévaluation sur ľéchelle graphique fut diminuée au mois après traitement, à partir des valeurs initiales de 84.4 et 78.7 jusqu'à 9.6 et 15.2 dans les groupes post-herpétique et post traumatique respectivement et à 4.6 et 11.6 respectivement après un an alors que 89 pour cent des patients du groupe post-herpétique et 59 pour cent des patients du groupe post-traumatique étaient complètement guéris. Les effets secondaires ont été mineurs dans tous les cas. Ce travail semble indiquer que le traitement proposé est le traitement de choix dans la névralgie ďorigine herpétique et traumatique lorsque les stéroides ne sont pas contre-indiqués.
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References
Harley, C. Extradural corticosteroid infiltration. A follow-up study of 50 cases. Ann. Phys. Med.9: 22–28(1967).
DeMoragas, J.H. &Kierland, R.R. The outcome of patients with herpes zoster. Arch. Dermatol.75: 193–196 (1957).
Miller, L.H. &Brunell, P.A. Zoster, reinfection or activation of latent virus? Observa tions on the antibody response. Am. J. Med.49: 480–483 (1970).
Schimpff, S., Serpick. A. &Stoler, B. Varicella-Zoster infection in patients with cancer. Ann. Int. Med.76: 241–254 (1972).
Gordon, R.A. The application of nerve block in diagnosis and therapy. Can. Med. Assoc. J.60: 251–257(1949).
Long, D.M. &Hagfors, N. Electrical stimulation in the nervous system: the current status of electrical stimulation of the nervous system for relief of pain. Pain1: 109–123(1975).
Miller, R.D. Treatment of intercostal neuralgia with 10% ammonium sulphate. Proc. Am. Soc. Anesthesiol. Ann. Mtg. 171-172 (abstract) (1974).
Schurmann, K. Fundamental principles of the surgical treatment of pain.in Pain: Basic Principles-Pharmacology-Therapy, Eds. J.P. Payne and R.A.P. Burt, Churchill-Livingston, London, pp. 181–193 (1972).
Barry. P.J.C. &Kendal, P.H. Corticosteroid infiltration of the extradural space. Ann. Phys. Med.6: 267–273 (1962).
Dilke. T.F., Burry. H.C. &Grahame. R. Extradural corticosteroid in the management of lumbar nerve root compression. Brit. Med. J.2: 635–637 (1973).
Kim, S.I. &Sadove, M.S. Caudal-epidural corticosteroid in post-laminectomy syndrome: treatment of low back pain. Comp. Therap.1: 57–60 (1975).
Kletschka, H.D. &Sheehan, L.C. Editorial: Solu-Medrol for back pain. Minnesota Med.54: 207(1971).
Krampac, O. Long-term experiences with local administration of Depo Medrol (methyl prednisolone acetate) in the treatment of various rheumatic diseases. Rheumatizam22: 177–181 (1975).
Porsia, F. &Delre, D. A proposito di 100 casi di sindromi lombo-sciatalgiche trattate con cortisone peridurale. Minerva Med.66: 3231 (1975).
Sayle-Creer. W. &Swedlow. M. Epidural injections for the relief of lumbo-sciatic pain. Acta Orthop. Belgica35: 728–734 (1969).
Tkaczuk, H. Intrathecal prednisolone therapy in post-operative arachnoiditis following operation of herniated disc. Acta Orthop. Scand.47: 388–390 (1976).
Winnie. A.P. &Ramamurthy, S. Steroids for discogenic pain. Proc. VI World Congress Anesthesiol. Am. Elsevier Pub. Co. Inc., N.Y. p. 139 (abstract) (1976).
Forrest, J.B. Management of chronic dorsal root pain with epidural steroid. Can. Anaesth. Soc. J.25: 218–225 (1978).
Ohnhaus, E.E. &Adler, R. Methodological problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale. Pain1: 379–384 (1975).
Libman, R.H. Treatment of post-herpetic neuralgia. J.A.M.A.239: 193 (1978).
Eaglstein, W.H., Katz, R. &Brown. J.A. The effect of early corticosteroid therapy on the skin eruption and pain of herpes zoster. J.A.M.A.211: 1681–1683 (1970).
Perkins, H.M. &Hanlon, P.R. Epidural injection of local anaesthetic and steroids for relief of pain secondary to herpes zoster. Arch. Surg.113: 253–254 (1978).
Carron. H. Relieving pain with nerve blocks. Geriatrics33: 49–57 (1978).
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Presented in part to the 2nd International Congress on Pain, Montreal, August 27, 1978, and the Annual Meeting of the Canadian Anaesthetists' Society, Edmonton, June 1979.
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Forrest, J.B. The response to epidural steroid injections in chronic dorsal root pain. Canad. Anaesth. Soc. J. 27, 40–46 (1980). https://doi.org/10.1007/BF03006847
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DOI: https://doi.org/10.1007/BF03006847