Postherpetic neuralgia

[newbie04]

I’ve had many patients in the past that are difficult to treat (read refractory).

I have an 85yo patient with PHN following T12 and L1 dermatomes on the right.

-tried: opiates in the past; does not want narcs, didn’t tolerate TCAs
-currently on: Gabapentin (dose limited by renal insufficiency), on Cymbalta 60mg daily and Lidoderm.


I did a T12-L1 interlam a few weeks ago. First time his pain has been below an 8 in the last 3 years since onset. Only lasted 3 days (80mg Depo and 3ml PFNS).

Planning to repeat interlam in the future with more volume and anesthetic.

Any suggestions for longer lasting relief (these patients have been hard for me to treat as they have continued pain despite maxing out adjuvant meds, etc)?



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[lobelsteve]

qutenza. stinks.

rfa of icnb.
scs

 

[nvrsumr]

Tfesi

 

[Malayil]

DRG trial above and below leads work I hear from Physicians who did it for this diagnosis.

 

[Ducttape]

Qutenza.

Prob won’t work. Then go to SCS.

 

[clubdeac]

pRFA of the right T12/L1 DRGs and then squirt in some dexa and marcaine

 

[painfree23]

Qutenza.

Prob won’t work. Then go to SCS.

What's the protocol for qutenza? Do u have the patients pick up their own patches and then bring them from the pharmacy?

What do u bill it as?

 

[Timeoutofmind]

I’ve had many patients in the past that are difficult to treat (read refractory).

I have an 85yo patient with PHN following T12 and L1 dermatomes on the right.

-tried: opiates in the past; does not want narcs, didn’t tolerate TCAs
-currently on: Gabapentin (dose limited by renal insufficiency), on Cymbalta 60mg daily and Lidoderm.


I did a T12-L1 interlam a few weeks ago. First time his pain has been below an 8 in the last 3 years since onset. Only lasted 3 days (80mg Depo and 3ml PFNS).

Planning to repeat interlam in the future with more volume and anesthetic.

Any suggestions for longer lasting relief (these patients have been hard for me to treat as they have continued pain despite maxing out adjuvant meds, etc)?



Sent from my iPad using SDN mobile

Maybe topamax or keppra

 

[Ducttape]

nowadays, the patient has to call their insurance to see which specialty pharmacy will be able to get the medication for them. the patient picks up the meds then brings it in to the clinic.

I just bill only for a follow up appointment and some extended stay add on code.

 

[Orin]

I'd support stimulation, but there are also some data to support getting back on an antiviral despite the lack of vesicles/rash to reduce low grade viral load in the ganglion.

Some folks talk/publish about doing peripheral stim for this, but I'm not sure that makes much sense, and DRG at the level seems a bit off as well, but above/below or conventional DC stim seems reasonable.