Postherpetic Neuralgia

At my orthopedic outpatients placement I’ve recently treated a patient who presented with postherpetic neuralgia with pain in her cervical region and associated headache.

As I was not familiar with the syndrome, I’ve sourced some information about it on the internet (www.mayoclinic.com, accessed 14/01/2007):

Postherpetic neuralgia is a painful condition affecting the nerve fibers and skin. It's a complication of shingles, a second outbreak of the varicella-zoster virus, which initially causes chickenpox. A case of shingles usually heals within a month. But some people continue to feel pain long after the rash and blisters heal. This pain is known as postherpetic neuralgia.

The symptoms of postherpetic neuralgia are generally limited to the area of the skin where the shingles outbreak first occurred. They may include: sharp and jabbing, burning, or deep and aching pain; extreme sensitivity to touch and temperature change; itching and numbness; headaches.

In rare cases, patients might also experience muscle weakness or paralysis — if the nerves involved also control muscle movement.

Treatment for postherpetic neuralgia depends on the type of pain experienced. Possible options include: Lidocaine skin patches, antidepressants, certain anticonvulsants, injected steroids, painkillers, transcutaneous electrical nerve stimulation (TENS), spinal cord or peripheral nerve stimulation.

In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few don't receive any relief. Although some people must live with postherpetic neuralgia the rest of their lives, most people can expect the condition to gradually disappear during the first three months. For about 10 percent to 20 percent of people with postherpetic neuralgia, the pain may persist for a year or more.

The patient I’ve treated mainly presented with pain on active movement and ↓AROM into SF bilaterally and extension. On assessment her upper trapezius on both sides had trigger points reproducing her pain locally and referred (headache), and the insertion of splenius capitis and semispinalis capitis at the occiput were tender and reproduced her pain. On PPIVM’s I found normal movement. I was unable to assess PAIVM’s due to tissue tenderness.

I therefore decided to treat her muscular symptoms, performing STM and very light trigger point release as the patient was still very tender to touch. My reasoning behind is that due to the hypersensitivity of the nerve, the muscle had reacted into local spasm, creating a trigger point. A contributing factor for her muscle soreness could be pain provoked posture, making her lift her shoulders because her neck had been so sore for a while.

Has any one had a similar case where a patient presented with muscular soreness due to neuralgia and how did you treat it? Any other ideas, suggestions or comments…

Thanks,

Edith