Role of repetitive intracutaneous injections with local anesthetics and steroids for postherpetic neuralgia
The management of established postherpetic neuralgia (PHN) is strenuous and often disappointing. The researchers analyzed the efficacy of repetitive intracutaneous injections with local anesthetics and steroids in acute thoracic herpes zoster (HZ) pain, herpetic eruption, and incidence of PHN in this study.
Total 93 patients with acute thoracic HZ were assigned to obtain a standard treatment of antiviral medication with p.o. analgesics or standard treatment with addition of repetitive intracutaneous injections of local anesthetic and steroid mixture. When visual analog scale (VAS) was ≥ 4, patients were allowed for tramadol. At first visit and 1, 2, 4, 12, and 24 weeks after treatments end, VAS was used as pain assessment.
During study, the VAS scores of the intracutaneous injection group were significantly lower as compared to the standard treatment group. The intracutaneous injection group also described shorter duration of pain and skin eruption than the control group (P = 0.005 vs P < 0.001, respectively). Total 12.8% patients in the intracutaneous injection group reported zoster-associated pain, compared with 47.8% in standard treatment group (P < 0.001) at 1-month post-therapy. The prevalence of PHN was still significantly lower in the intracutaneous injection group than the standard treatment group at 3 and 6 months’ post-therapy. EuroQol VAS scores were notably higher in the intracutaneous injection group vs standard treatment group (P < 0.001).
Thus, we inferred that the repetitive intracutaneous injections with local anesthetics and steroids plus standard treatment significantly decreased the duration of pain and herpetic eruption and incidence of PHN.