Can postherpetic neuralgia be completely cured: a three-tiered treatment regimen for postherpetic neuralgia

Can postherpetic neuralgia (PHN) be completely cured? This is the ultimate purpose of the patient's medical treatment, and it is also the only wish of the doctor to

Shingles is the result of latent varicela zoster virus (VZV) re-activating, replicating and spreading along the affected sensory nerve when the body is immunocompromised, causing skin lesions and pain

The patient's lack of understanding of the residual neuralgia may stem from the traditional concept that "pain is a symptom", while the doctor has developed a strong interest in the mechanism of its occurrence and persevered in the exploration

Such a complex mechanism of occurrence produces a diversity

The complexity of PHN's mechanism of occurrence and the diversity of clinical manifestations have led to a wide variety of therapeutic drugs and means and uncertainties

Minimally invasive therapy is the core technology of pain treatment of PHN

The exact mechanism of pulsed RF has been a hot topic

Corresponding clinical studies have also confirmed the clinical efficacy of PRF in the treatment of PHN

The analgesic mechanism of spinal cord electrical stimulation is based on the "Gate Theory" theory published by Melzack and Wall in 1965, that is, stimulating large-diameter Aβ fibers can activate inhibitory interneurons in the dorsal corner of the spinal cord, thereby attenuating the transmission

The application of intrathecal local anesthesia for intraoperative analgesia and the resolution of postoperative pain has a long history, but the advent of intrathecal drug infusion systems has benefited from advances in computer technology and the materials industry, as well as the development of pharmacology (opioid analgesics, local anesthetics, muscle relaxants) and the improvement

The common feature of the above non-neurodestructive methods for the treatment of PHN is to regulate the neural function of peripheral and central sensitization under the principle of "no injury", relieve pain, shorten the course of the disease, reduce systemic medication and adverse drug reactions, reduce long-term medical resource consumption, and improve the quality of life of

In summary, the pain department treatment PHN protocol can be divided into the following three ladders: calcium channel modulators, antidepressants, and topical lidocaine are the first-line drugs for the treatment of PHN, ranking first in the ladder; When the first ladder medication is not effective or the person with moderate and severe pain may be short-term addition of opioid agonists, nonsteroidal anti-inflammatory drugs or other analgesic drugs, as appropriate, this is the second ladder of PHN therapy; As the core technology of the pain department, minimally invasive treatment can be performed in a timely manner, which is the third ladder

Note: The commonly used drugs for first-order calcium channel blockers are pregabalin, gabapentin, etc.

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Now to answer the question at the beginning of the article, from the research status of PHN's mechanism to the enrichment of clinical technical means and the continuous improvement of the level of diagnosis and treatment, PHN can be clinically cured; On the other hand, it also has the same complexity as other chronic diseases, and patients with different degrees of pain who have a prolonged course of the disease must be treated with long-term comprehensive treatment