What
invasive procedures can be used for the treatment of PHN?
Over time, various invasive measures have been
employed for PHN pain; however, none has proven to be beneficial. When one
looks at the literature, the lack of ran-domized, controlled studies does not enable
one to recom-mend one invasive procedure over another. Sympathetic blocks have
been used for the treatment of pain from PHN; however, their efficacy has not
been proven in large-scale studies. Simple infiltration of the painful area
with local anesthetics and steroids has been employed by some prac-titioners as
a way to provide immediate pain relief, and with the hope of benefiting the
patient by the steroid’s peripheral action on nerve endings. Somatic nerve
blocks, while providing transient pain relief, have never shown any
long-lasting benefit. A recent study from Japan showed excellent, sustained
pain relief with the use of intrathecal methylprednisolone and lidocaine;
however, the results have been questioned and this therapy has not gained widespread
acceptance. Other modalities such as spinal cord stimulation and dorsal root
rhizotomies have also been described with varying results.
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