Treatment and diagnosis of herpes zoster neuralgia

Herpes zoster neuralgia is relatively difficult to treat. Generally, when the early symptoms are relatively mild, it can be treated with oral medications, mainly some nerve nourishing drugs and drugs to relieve neuralgia, such as carbamazepine, gabapentin, etc. So how should we treat patients who are in severe pain?

Key points in the diagnosis of postherpetic neuralgia

1. A clear history of herpes zoster in the corresponding nerve innervation area;

2. Pain that persists and/or recurs (>3-6 months) after the rash in the area innervated by the corresponding nerve has healed;

3. Differential diagnosis from certain neuralgia such as trigeminal neuralgia, intercostal neuralgia, etc.

treat:

1. Treatment of underlying or concomitant diseases;

2. Nutritional support and immune enhancement treatment:

① Rest and proper exercise;

②Intravenous nutrition: amino acids or fat emulsion; Gastrointestinal nutrition: full energy; vitamins;

③Drugs: interferon, globulin, thymosin, BCG, etc.

3. Anti-Virus:

① First choice: intravenous acyclovir; oral acyclovir can also be used;

② Patients with renal insufficiency can use ganciclovir or faciclovir;

③ For local application, acyclovir lotion, acyclovir ointment, or even iodine, phthalamide, or calamine lotion can be applied externally;

4. Nutrition and nerve repair drugs:

VB12 or methylcobalamin; neurotropin; nerve growth factor; drugs to improve microcirculation;

5. Pain medication:

①Including opioids, antidepressants and anti-epileptic drugs, NSAIDs, topical drugs, etc.;

② The three-step therapy is used as a reference, from NSAIDS to weak opioids to strong opioids, among which the use of opioids is particularly important; antidepressants and anti-epileptic drugs are often used for neuropathic pain;

③ Opioids: tramadol, oxycodone, morphine, fentanyl (Durogesic patch), etc.; prevention and treatment of side effects: respiratory depression, gastrointestinal reactions, constipation, etc.

④ Antidepressant and anti-epileptic drugs: Amitriptyline 25mg/d-150mg/d is the first choice; carbamazepine can be used for paroxysmal or pulsatile pain; others include clomipramine, gabapentin, etc.

⑤ Topical medications: Voltaren emulsion: generally used after herpes heals; Piyanping cream: used for skin itching; Enna cream and lidocaine patch

6. Nerve Block:

① Peripheral nerve block; epidural block, subarachnoid block, sympathetic nerve block, nerve damage, total spinal anesthesia

② Nerve block drugs: usually include local anesthetics, hormones, antiviral drugs, and neurotrophic drugs.

③Nerve block is generally performed 2-3 times per week;

④ For herpes zoster, appropriate nerve block can usually completely block the pain;

⑤ The therapeutic effect is usually reflected in pain relief, prolonged pain interval, reduced range, etc. Those who do not have the above reactions should use other blocking methods instead.

⑥ Neurodestruction is used for patients with intractable pain but who are effectively treated with simple nerve block; neurodestruction methods include radiofrequency, chemical drugs including anhydrous ethanol, glycerol, phenol glycerol, etc.;

⑦ Total spinal anesthesia is used for patients with intractable pain who are ineffective with simple nerve block;

7. Physical therapy:

Promotes healing of herpes such as ultraviolet light;

For neuralgia, such as ultra-laser

8. Other treatments: Intradermal injection of botulinum toxin

9. Treatment of special herpes zoster

① Herpes zoster ophthalmicus: It is mainly treated with corticosteroids, usually local eye drops are sufficient, and systemic application can be used in severe cases; secondly, the application of antiviral drugs, commonly used eye drops include acyclovir, virazole, herpes net, phthalamide, etc.; acyclovir eye drops should be the first choice for HSV-I keratitis. Atropine is used to dilate the pupil to prevent corneal adhesion;

② Herpes zoster oticus: Large doses of hormones are used in the acute phase to relieve pain and accelerate the recovery of facial paralysis.