Efficacy of continuous epidural infusion with epidural electric stimulation compared to conventional continuous epidural infusion for acute herpes zoster management: A retrospective study

Abstract

Background: A continuous epidural infusion is commonly used in clinical settings, and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacy of conventional continuous epidural infusion to that of continuous epidural infusion where the catheter is specifically guided by electric stimulation to areas with neurological damage in the treatment of zoster-related pain and prevention of postherpetic neuralgia. Methods: We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: contrast (conventional continuous epidural infusion), and stimulation (continuous epidural infusion with epidural electric stimulation). In the contrast group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the stimulation group, the site of herpes zoster infection was identified through electric stimulation using a guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2, and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6-month follow-up period after each procedure. Results: After adjusting for confounding variables, the pain score was significantly lower in the stimulation group than in the contrast group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the stimulation group than in the contrast group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the contrast group than in the stimulation group (95% confidence interval: 1.17-11.19, P = 0.03). Conclusion: Epidural drug administration to specific spinal segments using electric stimulation catheters may be more helpful than conventional continuous epidural infusion for improving pain and preventing postherpetic neuralgia in acute phase of herpes zoster.

Pregabalin alleviates postherpetic neuralgia by downregulating spinal TRPV1 channel protein

“…The pathogenesis of this disease is still poorly understood. However, it is believed that it may be closely related to age, regulation of expressions of related genes, and changes in immune function [6]. Age is the most important risk factor for postherpetic neuralgia.…”

Pregabalin alleviates postherpetic neuralgia by downregulating spinal TRPV1 channel protein

“…The pathogenesis of this disease is still poorly understood. However, it is believed that it may be closely related to age, regulation of expressions of related genes, and changes in immune function [6]. Age is the most important risk factor for postherpetic neuralgia.…”

Pregabalin alleviates postherpetic neuralgia by downregulating spinal TRPV1 channel protein

“…The pathogenesis of this disease is still poorly understood. However, it is believed that it may be closely related to age, regulation of expressions of related genes, and changes in immune function [6]. Age is the most important risk factor for postherpetic neuralgia.…”

Pregabalin alleviates postherpetic neuralgia by downregulating spinal TRPV1 channel protein

“…The pathogenesis of this disease is still poorly understood. However, it is believed that it may be closely related to age, regulation of expressions of related genes, and changes in immune function [6]. Age is the most important risk factor for postherpetic neuralgia.…”