Herpes zoster is a skin disease characterized by skin blisters and severe pain caused by the varicella-zoster virus. It is usually seen in the elderly, diabetic, oncologic and other immunocompromised individuals. The course of the disease is generally divided into the prodromal phase, the herpetic phase, the recovery phase and the sequelae symptoms (painful phase).
Postherpetic neuralgia is defined as the persistence of painful throws three months (also considered 4-6 weeks) after clinical healing of cutaneous herpes. It is one of the “kings of pain” along with trigeminal neuralgia. Postherpetic neuralgia is mainly a persistent or paroxysmal cutting, stabbing, electric shock-like or burning pain, throbbing pain, and may be accompanied by mild itching, tightness, ankylosis or twitching. Sometimes even intramuscular injection of dulcolax is difficult to stop the pain, and some patients commit suicide as a result.
Postherpetic neuralgia may occur in about 10% of patients with shingles, often for a few months, but also for up to 5 to 10 years. The incidence of postherpetic neuralgia increases with age, with a prevalence of about 40% to 50% over the age of 60 and up to 70% over the age of 70.
Factors affecting the occurrence of postherpetic neuralgia.
1. age: the older the age, the higher the incidence.
2. the more severe the early pain, the higher the incidence
3, severity of lesions, the more blisters the larger the area of lesions, the higher the incidence
4. body temperature: the higher the incidence of early body temperature over 38.5°C
5. abnormal sensation of the lesions: the more pronounced the hyposensitivity, the higher the incidence.
6. gender: higher incidence in females than in males
7, the lower the level of humoral and cellular immunity, the higher the incidence
8, whether early onset is timely, the higher the incidence of early treatment about delayed
9, concomitant diseases: diabetes, tumors, immune system diseases, application of corticosteroids and immunosuppressive agents, etc., the higher the incidence
Treatment.
I. Oral drugs
1, first-line drugs: amitriptyline, gabapentin.
2, second-line drugs: antidepressants (sertraline), etc., tramadol, oxycontin or topical lidocaine gel, ketoprofen gel, etc.
3, third-line drugs: morphine, lamotrigine, etc.
4. lexon 60mg orally 3/day, ibuprofen 0.2 orally 3/day, carbamazepine 0.1-0.2 orally 3/day, dalantin 0.1 orally 3/day, vitamin B1, B12, methylcobalamin 500μg intramuscularly 1/every other day or 500μg orally 3/day, etc.
5. prednisone 30-45mg daily for 7-10 days.
II. Injection therapy.
1, Kaiser 10μg + saline 10ml slow intravenous push (or both doubled).
2.Deboxone 1-2ml intramuscular injection.
3, nerve root block, epidural injection, intrathecal injection, the effect is very good, immediate effect, can be injected several times.
Third, physical therapy: red and blue light, NB-UVB, helium-neon laser, etc.
IV. Nerve destruction treatment: alcohol, local injection of Adriamycin or surgical severing of the nerve, this treatment is the last choice.