Petersen Karin L, Rice Frank L, Suess Fred, Berro Marlene, Rowbotham Michael C
Department of Neurology, UCSF Pain Clinical Research Center, University of California-San Francisco, 1701 Divisadero Street, Suite 480, San Francisco, CA 94115, USA.
Pain. 2002 Jul;98(1-2):119-26. doi: 10.1016/s0304-3959(02)00029-5.
We present a case of longstanding PHN treated by skin excision of the area of greatest pain (11.3 x 26.0 cm(2)). The operation reduced pain, eliminated tactile allodynia, and facilitated greatly reduced medication use over a 1-year follow-up period. Fourteen punch biopsies and 10 strips of skin (each 10 mm long) from the excised painful PHN skin were qualitatively assessed by double-label immunofluorescence using antibodies against protein-gene-product 9.5 (PGP9.5), 200 kDa neurofilament protein (NF), calcitonin gene-related peptide (CGRP) and vanilloid receptor-1 (VR-1). Compared with a punch biopsy from mirror image skin, the pattern of cutaneous innervation in PHN skin was consistently and substantially different. The results may explain the anatomical basis of the capsaicin-response test and have implications for our understanding of clinical mechanisms underlying PHN pain.
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