2.3.6 Acute and Postherpetic Neuralgia

Varicella-zoster virus infection or reactivation ("shingles") is more likely to occur in patients with cancer than in the general population because of the higher incidence of immunosuppression in the former. Zoster neuralgia may cause acute and chronic pain (Rusthoven, Ahlgren, Elhakim, et al., 1988). Disseminated zoster is twice as likely to occur in patients with progressive tumor than those in remission (Rusthoven, Ahlgren, Elhakim, et al., 1988). Thoracic and cranial dermatomes are most commonly affected, and the incidence of postherpetic neuralgia (pain after healing of rash) increases with age (Watson, Evans, Reed, et al., 1982).

Varicella-zoster virus infection is characterized by a burning, aching pain. Lancinating or shocklike pain may be superimposed in the area of the crusted (or healed) hermetic skin lesions, in which there is usually sensory loss. Hyperpathia may be profound. For acute foster, antiviral therapies in combination with analgesics are recommended. For postherpetic neuralgia, antiviral therapies are of limited use, and therapies for neuropathic pain are used (see Chapter 3). Empiric observations suggest that nerve blocks during acute herpes foster infection reduce pain, shorten the acute episode, and prevent the emergence of postherpetic neuralgia (Bonica, 1990). Treatment approaches for neuropathic pain are discussed later (see also Figure 1).

Related Chunks

Abdominal Pain

Physical Modalities

Counterstimulation

TENS

Introduction (Invasive nonpharmacologic interventions)

Radiation Therapy

Other Therapeutic Applications

Medical Interventions

Index