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Postherpetic neuralgia (PNH) is the most common chronic complication of herpes zoster (HZ), PHN patients are often accompanied by unbearable severe pain, which lasts for a long time, seriously affecting daily work and life, and HZ and PHN are currently treated There are many approaches, but the results may not be very satisfactory, and how to effectively manage the pain of PHN in the long term remains a challenge
for clinicians.
On the issue of "postherpetic neuralgia", Yimaitong had the honor to interview Professor Wang Yong from the General Hospital of Aviation of China Medical University The second phase explains the nerve block treatment of PHN and the characteristics and difficulties of the diagnosis and treatment of PHN in elderly patients
.
(For details of the first issue, see Professor Wang Yong's Interview: Diagnosis and Treatment Strategies for Postherpetic Neuralgia (I).
)
Yimaitong:
Nerve block is an effective treatment for postherpetic neuralgia, how to choose the site of nerve block?
Wang Yong
professor
disease.
If it is shingles on the face, most of it is emitted from the trigeminal meniscus, so the nerve block is in the trigeminal meniscus
.
Herpes zoster on the upper limbs and neck is emitted by the dorsal root ganglia of the neck, so the nerve block is located in the neck
.
While thoracic and abdominal shingles originate from the dorsal root ganglion of the chest, shingles of the lower extremities may be in the dorsal root ganglia
of the lower back.
Therefore, it is important to determine the injection site
of the nerve block according to the site of onset.
Yimaitong:
Postherpetic neuralgia is more common in middle-aged and elderly people, and it is often combined with a variety of chronic diseases, what problems need to be paid attention to during treatment?
Wang Yong
professor
of depression and suicide.
Postherpetic neuralgia is known as the undying cancer of the pain discipline, so its long-term pain is definitely very disturbing to the lives
of the elderly.
For older people, postherpetic neuralgia requires attention to the following:
First, early diagnosis, early intervention, and early treatment are the most important aspects of
treating herpes zoster and postherpetic neuralgia.
Many shingles do not start out and are painful and then appear shingles
.
Therefore, early detection in this case is the most important way to
prevent postherpetic neuralgia in the elderly.
If the following three points are met, even if there is no blistering, it should be considered shingles
.
(1) Unilateral onset
.
Generally, shingles occurs only on one side of the body, and it never crosses the midline, basically around
the midline.
For example, when the left side is onset, the left front to the sternum may cross a little, but the right side does not hurt at all, and the left side is all painful
.
(2) Pain is characterized by obvious pain at night, especially in the second half of the night
.
(3) Most of the occurrence of shingles, even if there is no blistering, may be accompanied by sensory impairment
.
The sensory quantitative tester can re-quantify sensation and can test for sensory disturbances in the painful area, which is normal
on the opposite side.
If the above three points are not detected, when no other organic disease can be detected and shingles is highly suspected, even if there is no blistering, early intervention can be followed to herpes to prevent residual neuralgia
.
For elderly patients, shingles neuralgia will have the following characteristics:
(1) Diabetes, if the patient has diabetes, there is a high probability of leaving sequelae
.
(2) The area of shingles is particularly large
.
(3) If it is accompanied by fever, it is easy to leave sequelae
.
(4) The pain is particularly intense, and some shingles do not have many blisters, and the pain is not severe, indicating that it is self-limited and can heal
by itself.
However, if the pain is particularly intense, it is also easy to leave sequelae
.
In summary, the older you are, the more diabetes, the more intense the pain, accompanied by fever, and the larger the area, the more likely it is to leave sequelae
.
For elderly patients, if the above conditions occur, early and active intervention is necessary to prevent the occurrence of postherpetic neuralgia
.
Wang Yong
professor
.
Not just postherpetic neuralgia, there are many patients with chronic pain who suffer from depression and anxiety
.
At present, our department may be the only pain department in the country that routinely conducts psychological assessment and sleep assessment on the Hamilton Anxiety Scale for inpatients on the first day of hospitalization, and will consult the psychology department as soon as it is found that the patient has this condition
.
Second, if it is a patient with long-term pain, the drug
will be adjusted.
Therefore, all patients with shingles must do a routine thing to do, which is to do a psychological evaluation
.
If psychological problems arise, further intervention
is required.
The intervention has three aspects:
First, consult a psychiatrist for drug intervention
.
Second, electroconvulsive therapy, that is, electroconvulsive without convulsions, mainly treats moderate to severe depression, and suitable patients can consider electroconvulsive therapy
.
.