Lumbar Sympathetic Block for Intractable Lower‐Limb Postherpetic Neuralgia: Report of Two Cases

Abstract

Lumbar sympathetic block is a commonly used technique for sympathetically mediated pain syndromes. Postherpetic neuralgia (PHN) is also accepted to be associated with sympathetic system activation. While sympathetic blocks were utilized for upper-extremity or face-related PHN, there has not been any report regarding lower-extremity PHN, as it is an uncommon region. Here, we present two cases of systemic drug-resistant PHN in lower limb, relieved with lumbar sympathetic block. Both patients had at least 50% reduction in numeric rating scale (NRS) scores at the end of 6 months. Lumbar sympathetic block could be considered in the treatment of lower-limb PHN. More reports and controlled trials are needed for further understanding the role of the intervention in this neuropathic pain syndrome. &

Retrospective Evaluation of the Effect of Lumbar Sympathetic Blockade on Pain Scores, Fontaine Classification, and Collateral Perfusion Status in Patients with Lower Extremity Peripheral Arterial Disease

“…Ozturk et al presented a case report assessing LSB on pain relief in two patients with systemic drug-resistant post-herpetic neuralgia in the lower limb. In that report, both patients had at least a 50% reduction in NRS scores at the end of six months [27]. In the present study, we described an effective (≥50%) pain relief after LSB with a mixture of the local anesthetic and steroid, and our results are consistent with the literature evaluating the effect of LSB on the duration and intensity of pain in patients with PAD.…”

“…Although several studies have evaluated the effect of LSB with local anesthesia and/or a steroid combination on pain in patients with different kinds of pathologies, to our best knowledge, there is no study in the literature evaluating the effect of LSB with a steroid and local anesthetic mixture in patients with PAD in whom revascularization is impossible [23][24][25][26][27].…”

Efficacy of the lumbar sympathetic ganglion block in lower limb pain and its application prospects during the perioperative period

“…In addition, postherpetic neuralgia is a common and intractable NP, and its incidence and prevalence gradually increase with age. The study found that patients with postherpetic neuralgia experienced a marked reduction in pain and improvement in quality of life after LSGB 39,40 . Moreover, diabetic peripheral neuropathy (DPN) and diabetic foot are one of the most common and serious complications of diabetes, respectively, often with severe pain and tissue destruction in the lower extremities, which cannot be ignored.…”

“…The study found that patients with postherpetic neuralgia experienced a marked reduction in pain and improvement in quality of life after LSGB. 39 , 40 Moreover, diabetic peripheral neuropathy (DPN) and diabetic foot are one of the most common and serious complications of diabetes, respectively, often with severe pain and tissue destruction in the lower extremities, which cannot be ignored. More and more evidence showed that sympathetic nerve blockade for DPN can lastingly provide durable pain relief and increase skin temperature on the affected extremity.…”

Lumbar sympathetic block for postherpetic neuralgia of lower limb: Familiar for a long time! – Comment to Ozturk et al., 2021 Pain Practice

“…I read the article describing lumbar sympathetic block (LSB) for two cases of post‐herpetic neuralgia (PHN) of the lower limb, published in the current issue (March 2021) 1 with keen interest. I congratulate the authors for presenting these two cases and appreciate them for their wonderful management.…”