Post-herpetic neuralgia (PHN) due to neural tissue varicella zoster viral infection can be debilitating chronic condition characterized by pain, burning and itching sensation along the involved nerve. Although any nerve can be involved, and its related dorsal root ganglia, more commonly involved are the sensory nerves of the head and trunk, along their specific sensory distribution (dermatome).
In the United States each year approximately 1,000,000 individuals develop herpes zoster. Of those individuals approximately 20%, or 200,000 individuals, develop PHN. About 10 % of people younger than 60, and about 40 % of people older than 60 end up developing PHN.
It usually follows herpes zoster outbreak (also known as SHINGLES), but it can begin in the absence of herpes zoster, then known as zoster sine herpete. The neuralgia typically begins when the herpes zoster vesicles have crusted over and begun to heal. Pain that persists beyond three months, is defined as PHN. After the initial acutely painful nerve involvement, skin discoloration, burning and itching, symptomatic treatment usually helps temporarily control these acute events. Unfortunately viral nerve infection permanently infects the involved sensory nerve, leaving patient to deal with chronic pain, burning and or itching along involved nerve’s skin dermatome.
From this point, a number of pain treatments are offered to patients by many specialists. Since the vast majority is focused on treating patient symptoms, a solution is seldom found. Unlike other specialties, peripheral nerve surgery is focused on the anatomical cause of chronic pain, ensuring the best possible chance for cure. Dr. Ducic had pioneered application of peripheral nerve surgery in the treatment of post-herpetic neuralgia patients.
Surgical Treatment of Post-Herpetic Neuralgia (Shingles)
You should see Dr. Ducic for chronic pain due to post-herpetic neuralgia, if your symptoms persist:
- Beyond three months after herpes zoster (shingles) diagnosis had been established and medical treatment initiated by your PCP or infectious disease doctor
- Pain persists for more than three months despite supportive medical care prescribed to you by your PCP or infectious disease doctor
Failure to intervene with definite treatment in a timely manner poses a risk for the chronic pain to evolve into more complex disorder with involvement of your central and autonomic nervous system, making treatment far more challenging and difficult. Therefore, peripheral nerve surgery has an important role in treating chronic post-herpetic neuralgia pain, giving patient a chance to eliminate dependence on pain medications and thus improve quality of life. As described in Dr. Ducic’s peripheral nerve surgery original and pioneering published studies, based on patient’s presentation and findings on physical exam, the involved sensory nerves are surgically identified and treated so they no longer generate pain. Similar principles are applied in the treatment of PHN patients.
During surgery for chronic post-herpetic neuralgia pain:
- You will receive anesthesia so you won’t feel any pain during the surgery.
- An incision is made over the involved nerve area(s) to access and remove painful nerves. In most cases the excised involved sensory nerves would result in numbness along affected skin area, while no motor deficits are expected. The skin is closed in anatomical layers.
- Ambulation is allowed immediately following the surgery, as tolerated.
- Peripheral nerve surgery for chronic post-herpetic neuralgia pain is usually an outpatient procedure; your dressing will be removed in about 3-5 days after surgery, while sutures are removed about one-three weeks later, depending on its location.
If you are not sure about your eligibility for surgery, and if you are not in the Washington, D.C. area, you can send me your records so I can determine if you are a good candidate for treatment. Visit my patient forms page for a downloadable form.
