Zibly Zion, Sharma Mayur, Shaw Andrew, Deogaonkar Milind
Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, USA.
Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, USA.
Clin Neurol Neurosurg. 2014 Dec;127:101-5. doi: 10.1016/j.clineuro.2014.10.009. Epub 2014 Oct 23.
Post herpetic neuralgia is a chronic, debilitating pain with very few management options and is often refractory to treatment. We present our experience with a series of 4 patients who underwent subcutaneous peripheral field stimulation for treatment of thoracic post herpetic neuropathic pain.
Four patients with intractable thoracic post herpetic neuropathic pain were operated after maximum medical treatment and a neuropsychological evaluation. Multiple percutaneous electrodes were placed in the subcutaneous plane in the region of pain for a 7-day trial. Following a successful trial (more than 50% reduction of pain), the electrodes were then internalized and attached to a pulse generator. Visual analog scores (VAS) were studied during the preoperative, immediate postoperative and last follow-up visits. Long-term treatment results were determined by retrospective review of medical records. Average follow-up period was 28.2 months.
All 4 patients showed persistent improvement in their VAS pain scores with an average improvement of more than 75%. There were no treatment failures and no complication requiring re-operation was reported.
Peripheral field stimulation for the treatment of post herpetic neuropathic pain is a safe and effective method for pain relief for an extremely complex problem with very few solutions. Patient selection and proper lead placement is most important for the success of treatment.
带状疱疹后神经痛是一种慢性、使人衰弱的疼痛，治疗选择极少，且常常对治疗无反应。我们介绍了对4例患者进行皮下外周区域刺激以治疗胸部带状疱疹后神经病理性疼痛的经验。
4例难治性胸部带状疱疹后神经病理性疼痛患者在接受了最大程度的药物治疗和神经心理学评估后接受手术。在疼痛区域的皮下平面放置多个经皮电极进行为期7天的试验。在试验成功（疼痛减轻超过50%）后，将电极植入体内并连接到脉冲发生器。在术前、术后即刻和最后一次随访时研究视觉模拟评分（VAS）。通过回顾医疗记录确定长期治疗结果。平均随访期为28.2个月。
所有4例患者的VAS疼痛评分均持续改善，平均改善超过75%。没有治疗失败的情况，也没有报告需要再次手术的并发症。
外周区域刺激治疗带状疱疹后神经病理性疼痛是一种安全有效的缓解疼痛的方法，可用于解决极少有解决方案的极其复杂的问题。患者选择和正确的电极放置对治疗成功最为重要。
