Nerve Operation for Treatment of Shingles
Shingles (herpes zoster) presents as a painful rash with clusters of blisters. It is caused by the reactivation of the varicella zoster virus, which remains dormant in nerves for years after an initial chickenpox episode. Usually, symptoms of active shingles last for three to five weeks. Severe, persistent pain that resists medication may warrant surgical cutting of the affected nerve.
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Procedure and Indications
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Neurosurgical treatment of shingles is seldom employed and involves cutting (transecting) the nerve branches that conduct the pain sensation. The procedure is indicated only in the most severe forms of postherpetic neuralgia (PHN).
Postherpetic neuralgia
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This most common complication of shingles is characterized by pain that lasts for months or years after the rash heals. Most cases of PHN can be managed by the primary care physician and resolve within a year, usually with the help of multiple medications, including topical anesthetics, capsaicin, anticonvulsants, opioids and antidepressants. Severe cases benefit from nerve-blocking injections (e.g., facial herpes zoster), spinal cord electrical stimulation or, as a last resort, from surgery that interrupts the transmission of pain sensation.
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Significance
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PHN is experienced by 10 to 15 percent of shingles sufferers. It significantly impairs the quality of their daily life. The elderly are most frequently and seriously affected.
Perspectives
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Evidence for the efficacy of surgical and procedural interventions in PHN is still scant. Some interventions, such as steroid injection into the thecal space of the spinal cord near the affected nerve, remain controversial.
Warning
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These procedures are not without risks. Surgery has the potential to induce pain (including a dreaded complication called anesthesia dolorosa). Your eligibility depends on your particular medical history, present symptoms, age and health status. Talk to your doctor about a non-pharmacologic intervention.
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