Intercostal nerve blocks as prophylaxis against post herpetic neuralgia?

[Ligament]

Anybody know whether intercostal nerve blocks post shingles but BEFORE post herpetic neuralgia sets in act as prophylaxis against developing post herpetic neuralgia later on???

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[mille125]

Anybody know whether intercostal nerve blocks post shingles but BEFORE post herpetic neuralgia sets in act as prophylaxis against developing post herpetic neuralgia later on???

just use some nortriptyline....i dont understand why you would want to do this and it probably wouldn't work.....sometimes we just need to put our needles away........

 

[lobelsteve]

I've thought of doing SCS for CRPS before it sets in. Could be useful for the folks having foot/ankle/knee surgery.

It could be a 3 week trial and if they do not get CRPS we could pull the leads.
If they get CRPS we can put in a battery.

 

[SleepIsGood]

Anybody know whether intercostal nerve blocks post shingles but BEFORE post herpetic neuralgia sets in act as prophylaxis against developing post herpetic neuralgia later on???

I know at the ASA conference this past month there were various 'experimental" techniques discussed for PHN. As Steve mentioned, there was discussion of SCS, but not for prophylxis. Also, again not for preemptive pain relief, but there was discussion of pulsed RF of the specific DRG,etc in question.

Ligament. I think some sort of prophylaxis maybe a good idea. For example, we know that using epidural anesthesia vs general anesthesia can drastically decrease the recurrence of cancer s/p prostatectomies and breast lumpectomies,etc. Some of this has to do with the immune system being surprised by general anesthesia and NARCOTICS. So perhaps pre-emptively attacking the dormant DRGs would attenuate the occurence of PHN ?? 🙄

 

[Ligament]

just use some nortriptyline....i dont understand why you would want to do this and it probably wouldn't work.....sometimes we just need to put our needles away........

I did not say I wanted to do it this procedure for prophylaxis, I'm just asking whether its been researched. A neurologist friend of mine asked me the question and I did not have the answer, thus asking the SDN hive mind.

 

[mille125]

I know at the ASA conference this past month there were various 'experimental" techniques discussed for PHN. As Steve mentioned, there was discussion of SCS, but not for prophylxis. Also, again not for preemptive pain relief, but there was discussion of pulsed RF of the specific DRG,etc in question.

Ligament. I think some sort of prophylaxis maybe a good idea. For example, we know that using epidural anesthesia vs general anesthesia can drastically decrease the recurrence of cancer s/p prostatectomies and breast lumpectomies,etc. Some of this has to do with the immune system being surprised by general anesthesia and NARCOTICS. So perhaps pre-emptively attacking the dormant DRGs would attenuate the occurence of PHN ?? 🙄

i agree and it is nortriptyline

 

[joshmir]

neuraxial steroids has been described as having a role

based on mechanism, subcutaneous botox injection would likely help

there is an ASRA newsletter article devoted to this....clinical experience in the VA system at preventing shingles-----> PHN can find it online

 

[mille125]

neuraxial steroids has been described as having a role

based on mechanism, subcutaneous botox injection would likely help

there is an ASRA newsletter article devoted to this....clinical experience in the VA system at preventing shingles-----> PHN can find it online

neuraxial steroids and botox DEFINITELY help but should be saved for those that fail medication therapy which is a very low percentage especially if started during the first 3 months of symptoms.

 

[Tenesma]

i used to do a LOT of blocks (ESIs, intercostals) for shingles....

not anymore --- i have found that about 90% do well just by educating them on course of disease and rx w/ creams/patches/TCAs/neurontin...

the outcomes appear similar, so i am not sure i am going to return to doing a lot of injections for shingles...

 

[lovebailey2001]

Hi Tenesma, what do u do for the established PHN, apart from the meds coz they are not working! what abt a infusion of diluted LA in paravertebral space coz it will cover the sympatheticc as well. I have two old ladies with severe PHN in T7-8-9 dermatomal levels and not responding well to fairly high doses of Gabapin and Tryptomer. Plz guide...