Postherpetic Neuralgia
My RSS reader I found a particularly sad case. [http://mypills.biz/blog/393.html] Individual reporting the situation said he had had shingles in his face two years ago and was still having pain. He expressed the hope that Methadone would relieve his pain.
I have sad news for the poor soul. Methadone will NOT give him any lasting relief.
Postherpetic Neuralgia is in a category of pain called neuropathic. It is caused by damage to the nerves from the prior condition. When nerves get damaged either by diseases such as shingles, or by severing in an injury, the nervous system connections in the brain and the spinal cord and a changed. These changes frequently maintain pain along after the initial injury.
Treatments early in the course of shingles with nerve blocks will make the postherpetic neuralgia much less likely and generally much less severe.
The same nerve blocks done three years after the shingles are very unlikely to produce any benefit.
There are medicines which may be beneficial. These include antidepressants which inhibit both serotonin and norepinephrine reuptake. Antidepressants which only inhibit serotonin reuptake, the SSRI’s, produce no benefit at all in this condition. The other drugs that are beneficial are anticonvulsants. The antidepressants and anticonvulsants are commonly used together for this problem.
Frequently the drugs produce unacceptable side effects or inadequate relief. There is one other treatment that can give excellent benefit.
A spinal cord stimulator is frequently the most effective treatment available for postherpetic neuralgia. It involves putting a wire or two inside the spinal canal and up into the neck. Electrical pulses through these wires affect the spinal cord and helped to shut down the pain perception.
The chap who has this pain needs to consult an interventional pain treatment specialist. These are the physicians who are skilled in using all loads of treatment for pain and generally are very good at avoiding narcotics.
Most of us physicians who treat postherpetic neuralgia have no understanding of the things that I have just said. They seem to think that, if narcotics don’t relieve the pain, then the patient is crazy. Nothing could be farther from the truth!
I don’t know where this poor soul lives. But, there are interventional pain specialists operating pain clinics in most medium to large cities.
Live well.
