Abstract ID: A26
Abstract Title: Complex regional pain syndrome after herpes zoster infection
Poster Type: Poster
ABSTRACT BODY
Report of two cases who developed complex regional pain syndrome after herpes zoster infection.
Case1: 67 years old lady who presented with swelling, allodynia and atophic change of left arm for 2 months. She was diagnosed with Herpes zoster at medial aspect of left forearm 6 months ago, in which she was successfully treated with course of acyclovir. She developed persistent pain over the area of lesion despite after the disappearance of lesion. She was treated with variety of anticonvulsants, antidepressants and tramadol. All of these failed to alleviate her pain and gradually the entire left arm started swelling up with intense spontaneous pain, allodynia, loss function and deformity of left hand . At this point she was referred to pain clinic, and after treatment with series of left stellate ganglion block using local anesthetics and ketamine her symptom was dramatically improved. She can participate in rehabilitation program and regain function of her hand.
Case 2: 61 years old male presented with swelling of left lower extremities for 7 months after the attack of herpes zoster at left inner thigh toward medial side of knee. He described the constant throbbing pain with occasional lancinating pain along the prior herpetic lesion which was persistent after its healing, and only hyperpigmentation left. He also described the history of periodic flushing alternated with cold, bluish discoloration and allodynia of left lower extremity. He had received a course of acyclovir during the attack,and the lesion started to heal in 48 days after the initiation of drug. He had received multitude of medication for this pain including multiple anticonvulsants, antidepressants, non-steroidal anti-inflammatory drugs and opioids. Non of them help with his condition except the opioids, which alleviated the pain temporary. The diagnostic left lumbar sympathetic block at L3 level was performed under fluorosopic guidance with 0.25 % bupivacaine 2 cc and triamcinolone 20 mg. He demonstrated the dramatic improvement of left lower extremity with reduction of swelling, flushing, lancinating pain and disappearance of allodynia within 2 days after injection. He received repeated the same injection every otherday for 3 more times. At that point his VAS is 1-2 and he was off all the medication. Upon 6 months followup he reported only occasional tingling sensation 1-2 per weeks, and went back to work in his office. He was still off all medication. Only acetaminophen 500 mg was needed for periodic tingling sensation.
Conclusion : This two cases has demonstrated the development of complex regional pain syndrome after herpes zoster infection. Both of them spent several months trying on the various medication without good result. Their symptoms were eventually controlled with the invasive intervention. Perhaps if the intervention was tried earlier it may spare the medical cost and loss time on the patient part. The alternative technique beside medication should be considered in the management of pain such as this.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A26