Short-Term Peripheral Nerve Stimulation Relieve Pain for Elder Herpes Zoster Ophthalmicus Patients: A Retrospective Study

Abstract

Objective Ophthalmic postherpetic neuralgia (PHN) is the final stage of herpes zoster (HZ) ophthalmicus and a severe refractory neuropathic pain, thus there is no curative treatment that could alleviate pain and reduce the incidence of ophthalmic PHN now. The purpose of this study is to evaluate therapeutic efficacy of short‐term peripheral nerve stimulation (PNS) for elder patients with HZ ophthalmicus. Materials and Methods We performed a retrospective study from March 2015 to August 2019 in our pain department. All the HZ ophthalmicus patients underwent supraorbital nerve short‐term PNS were included. The patients' data, including numeric rating scale (NRS), 36‐Item short form health survey (SF‐36), and analgesic consumptions, were retrospectively analyzed. Severe side effects also were recorded. Results A total of 68 patients were enrolled in this study. The NRS scores were significantly decreased at different time points after short‐term PNS compared to baseline (p < 0.001). The SF‐36 scores, including general health, social function, emotional role, mental health, bodily pain, physical functioning, physical role, and vitality, were significantly improved at different time points after treatment (p < 0.001). The average dosages of tramadol and pregabalin administered (mg/d) were both significantly reduced compared to baseline (p < 0.001). There was no bleeding, infection, pain increase, and other side effects after treatment. Conclusions Short‐term PNS is an effective and safe therapeutic alternative for elder patients with HZ ophthalmicus and could reduce the incidence of ophthalmic PHN.

Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients

“…Han et al showed that short-term PNS on the SON to treat herpes zoster ophthalmicus achieved 50% pain reduction in a 12-month follow-up without complications (18). Wan and Song also showed that 94.2% (64/68) of patients obtained excellent pain reduction during a 6-month follow-up after shortterm SON PNS treatments in a retrospective study composed of 68 patients with herpes zoster ophthalmicus (19). In this case report, we treated two patients with short-term PNS on the ION in case 1 and SON and STN in case 2, respectively (Figures 3A,B), and both obtained excellent pain relief during a 3-month follow-up, consistent with the results of Han et al and Wan and Song.…”

“…In this case report, we treated two patients with short-term PNS on the ION in case 1 and SON and STN in case 2, respectively (Figures 3A,B), and both obtained excellent pain relief during a 3-month follow-up, consistent with the results of Han et al and Wan and Song. Numerous PNS studies have described the placement of the leads on the SON, STN, or ION, without mentioning of placement on the mandibular nerve (18,19,(21)(22)(23)(24)(25). Slavin and Wess suggested the lack of reports on using the PNS technique for the highly mobile mandibular area was due to the inherently high risk of stimulation lead displacement (11).…”

“…PNS refers to the placement of a lead near a nerve to cause direct stimulation. This electrical stimulation technique has been successfully used in the treatment of HZ-related trigeminal neuralgia ( 18 , 19 ). Its effect is attributed to the gate-control theory, which postulates that impulse transmissions in the nociceptive afferent pathway are modulated by the activity of large-caliber myelinated non-nociceptive A-fiber afferent nerves ( 11 , 20 ).…”

Implantable Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain: A Systematic Review and Meta-Analysis

“…The general criteria for a long‐term implantation in enrolled patients in this study were: 1) pain duration of over six months, 2) failure to control pain after conventional therapy, and 3) at least 50% pain reduction compared with baseline during stimulation trial. However, latest data have indicated that early intervention may prevent the development of postherpetic neuralgia with ophthalmic involvement (19,44). Surgical or traumatic injury of the trigeminal nerve are common etiologies for PNS therapy (17,18,29–32).…”

“…Another risk factor of complications may be associated with long‐term implantation. As for short‐term stimulation, no obvious complications were observed (19,44).…”