Abstract
Introduction: PHN is defined as pain persisting for more than 4 weeks after the rash has healed. Despite increasing understanding of pathophysiology and advances in therapy the quest for the penultimate therapy for PHN still remains elusive. Out of various treatment options available anticonvulsants or tricyclic-antidepressants drugs are preferred. Cryoanalgesia is routinely used in interventional pain management settings. Recently it has been successfully used in treating PHN by Calandria L.
Material & Methods: 50 Patients of PHN on daily oral amitriptyline (25mg) were randomly divided into two groups of 25 each; group ‘A’ received weekly cryoanalgesia {60-90 seconds by non-freezing cryo (liquid nitrogen) spray} and group ‘B’ received daily oral gabapentin (600mg) for 8 weeks. Efficacy was studied by a blinded investigator using visual analogue score (VAS), SF- McGill pain questionnaire (Sf-MGPQ). Safety was studied by appropriate investigations.
Results: Baseline mean VAS and Sf-MGPQ of group A and B were 100& 0.90 and 100& 0.90 respectively. At the end of 8 weeks mean VAS and Sf-MGPQ of group A and B were reduced to 14& 0.13 and10.4& 0.07 respectively. The difference in both the groups was not statistically significant (P=0.39)
Conclusion: Combination of cryoanalgesia and amitriptyline is well tolerated and its efficacy is equivalent to conventional therapy of gabapentin and amitriptyline.
References
- Gnann JW Jr, Whitley RJ. Clinical practice Herpes zoster. N Engl J Med 2002; 347: 340–346.
- B.Archer & D.J.Eedy. The Skin and the Nervous System. In: Burns T, Breathnach S, Cox N, Griffiths C, editor. Rook’s textbook of dermatology, 8th ed. West Sussex: Wiley-Blackwell Publishers; 2010.p. 63.6.
- Criton. Viral Infections. In: Valia RG., Valia AR, editor. IADVL Textbook of Dermatology, 3rd ed. Mumbai: Bhalani Publishers; 2008.p. 349.
- Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain. 2008;9:S37–S44
- Sugeng MW, Yosipovitch G, Leok GC. Post herpetic neuralgiaand the dermato-logist. Int J Dermatol. 2001 Jan;40(1):6-11
- Wu CL, Raja SN. An update on the treatment of postherpetic neuralgia.J Pain. 2008;9(1 Suppl 1):S19–S30
- Wu CL, Marsh A, Dworkin RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain. 2000;87:121–129.
- Xiao L, Mackey S, Hui H, Xong D, Zhang Q, Zhang D. Subcutaneous injection of botulinum toxin a is beneficial in postherpetic neuralgia. Pain Med. 2010 Dec;11(12):1827-33
- Mann S S, Dewan S P, Kaur A, Kumar P, Dhaw. Role of laser therapy in post herpetic neuralgia. Indian J Dermatol Venereol Leprol 1999;65:134-6.
- Andrea M. Trescot. Cryoanalgesia in Interventional Pain Management. Pain Physician 2003;6:345-360
- CalandriaL. Cryoanalgesia for post-herpetic neuralgia: a new treatment. Int J Dermatol2011 Jun;50(6):746-50.
- Watson CP, Evans RJ, Reed K, Merskey H, Goldsmith L, Warsh J. Amitriptyline versus placebo in postherpetic neuralgia. Neurology. 1982 Jun;32(6):671-3
- Rowbotham M, Harden N, tacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998;280(21):1837-42.
- Bonezzi C, Demartini L. Treatment options in postherpetic neuralgia. Acta Neurol Scand Suppl. 1999;173:25-35; discussion 48-52.)
Corresponding Author
Dhanraj D Chavan
KIMSDU, Karad, India