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NEURALGIA
AND ITS
MANAGEMENT
INCIDENCE
10
9
8
8.8
7
6
5
4
3
2
2.0
1
0
01 MONTH
03 MONTHS
01 YEAR
45
40
40.8
35
30
25
INCIDENCE
20
15
13.0
10
7.8
5
0
01 MONTH
03 MONTHS
01 YEAR
PATHOPHYSIOLOGY OF PHN
Varicella
neurochemical
FREQUENCY
PRE-DISPOSING
FACTORS
CLINICAL
PRESENTATION
SYMPTOMS:
Pain
- ranges from mild discomfort to severe
burning, aching or gnawing
- constant
Allodynia
Headaches
Fatigue
Sleep disturbances
SIGNS:
Cutaneous scarring of HZ lesions in the
affected areas
Altered sensations over the affected
dermatome
- Lowered threshold for cold, warmth
& vibration
- Poor two-point discrimination
Muscle weakness, tremor or paralysis -if
the nerves involved also control muscle
movement
DIAGNOSIS
History
Examination - dermatomal pattern of
distribution and the appearance of the herpes
zoster rash
PREVENTION
PRIMARY PREVENTION
CHICKENPOX VACCINE
Varivax vaccine
routinely given to children aged 12 -18
months to prevent chickenpox
also recommended for adults and older
children who have never had chickenpox
does not provide 100% immunity but
reduces the risk of complications and
severity of the disease.
SHINGLES VACCINE
Zostavax vaccine
helps protect adults over 60 who have had
chickenpox.
Recommended
that people over 60 have this vaccine
, regardless of whether or not they h
ave had shingles before
.
The vaccine is preventative, and is not
used to treat people who are infected.
SECONDARY
PREVENTION
TREATMENT OF PHN
OTHERS
TENS
PERIPHERAL NERVE STIMULATION
SPINAL CORD STIMULATION
SURGICAL INTERVENTION
1. ANALGESICS
TOPICAL AGENTS
Lidocaine Skin Patches
small, bandage-like patches that contain
lidocaine
must be applied directly to painful skin to
deliver relief for 04-12 hours.
avoid contact with mucus membranes
e.g. eyes, nose and mouth.
TOPICAL CAPSAICIN
an extract of hot chilli peppers
depletes substance P from nerve
terminals & desensitizes them
0.025 % cream (Zostrix) applied four times
daily
EMLA
A eutectic mixture of lidocaine and
prilocaine
Reported to be beneficial in pain relief
Aspirin
mixed into an appropriate solvent such as
diethyl ether may reduce pain
SYSTEMIC AGENTS
OPIOIDS
- Oxycodone (Oxycontin) 10 mg twice
daily
- a small risk of dependency exists
PAIN MODIFICATION
THERAPY
1. TRICYCLIC
ANTI- DEPRESSANTS
Affect key brain chemicals, such as
serotonin and norepinephrine
Influence how the body interprets pain
Dosages tend to be lower
Examples include
Amitriptyline 10-75mg /d
AMITRIPTYLINE
Single most effective drug
Anticholinergic and cardiovascular sideeffects must be considered
Given at bedtime to improve tolerance
and prevent daytime somnolence
2. ANTI-CONVULSANTS
effective in calming down nerve impulses
stabilize abnormal electrical activity in the
nervous system caused by injured nerves
Effective in patients who experience
stabbing pain in addition to the burning
sensation
Examples include
Gabapentin (Neurontin) 100-300mg/d
Pregabalin (Lyrica) 50-75mg/d
Lamotrigine (Lamictal)
Carbamazepine (Tegratol)
Phenytoin (Dilantin)
3. STEROIDS
METHYLPREDNISOLONE is injected into
the area around the spinal cord i.e
intrathecally
Effective for patients with chronic pain
Administered only after the shingles
pustular skin rash has completely
disappeared
Patients unresponsive to oral/topical
therapy should be considered
TRANSCUTANEOUS ELECTRIC
NERVE STIMULATION
PERIPHERAL NERVE
STIMULATION
SPINAL CORD
STIMULATION
SURGICAL TREATMENT
PROGNOSIS