Acupuncture treatment of post-herpetic neuralgia
Mendez C. M. MD, Cardoso T. MD, Jimenez I. Centro Internacional de Restauracion Neurologica.
Herpes zoster disease (HZ) is caused by varicela zoster virus. HZ typically presents as a vesicular rash involving the thoracic or lumbar dermatomes. Pain, tingling, or itching sensation in the affected dermatome often precedes the rash, which consists of irregularly sized vesicles on an erythematous base. Patients may also have systemic signs with fever, malaise, stiff neck, or headache. HZ produces pain by nerve involvement in one-third of cases. In some cases a persistent intense burning pain follows the initial acute illness. The discomfort may persist (particularly in the elderly) for months or years. The pain is localized over the distribution of the affected nerve and associated with fine tenderness to the lightest touch. Pathologically, HZ produces predominantly large fiber damage, resulting in reduced inhibitory input of large fibers on the secondary nociceptive cells. In the majority of healthy persons, herpes zoster remits within 3-4 weeks. The pain sometime is difficult to release, even with current medication.
A 56-years-old man patient with an intense, constant, deep burning pain in the right arm, with 3 month of evolution after a Herpes zoster infection in the ulnar and median nerve territories, rebellious to pharmacological treatment and an electrophysiological study which verifies severe lesion on right brachial plexus. He has a hypertension controlled with medication. He came with the diagnosis of neuralgia postherpes zoster and was treated with vitamins analgesic and steroids during a month and half; the last month, Carbamazepine and Neurobion without release of the pain. ThatÅfs why he was remitted to the Department of Traditional Chinese Medicine. In the evaluation, he complained of pain as was described before. At physical exam, it was found redness skin lesions in the ulnar and median nerve territories, burning pain with tender palpation in this area, and functional impairment of movement in right hand and arm (75%). He has insomnia since the beginning of the process. According to the bioenergetic diagnostic, it was considered as a syndrome of endogenous damp heat with a deficiency of QI and Yin and hyperactivity of the fire on liver and gall bladder. Stagnation of QI and blood in the channels and collaterals was also considered.
The general strategy was to release stagnation in channel and collaterals to promote free circulation of qi and xue; disperse heat damp pathogenic factor; tonify the Qi and regulate the affected Zang Fu. First phase of treatment was applied with a seven star needles in the affected area. Acupuncture in points Houxi SI-3, Neiguan P-6, Zhongchong P-9, Hegu L.I.-4, Dazhui DU-14, in dispersion, and Quze P-3, Shaohai HE-3, Quchi L.I.-11, Zusanli ST-36 with reinforcing methods, 3 times a week. A second phase of treatment reinforcing with needle the points Baxie, Waiguan SJ-5, Quchi L.I.-11, Dazhui DU-14, twice a week.
At the end of first moth of treatment, the pain was in 4 according to the visual analogue scale for pain. At the end of second month, pain was in 1 and follows with that until the 6th month when it was 0. The insomnia was 2 in a scale from 0 (no insomnia) to 10 (the condition of the patient at the beginning), and 0 at the end of the 2nd month. The functional impairment of the arm was 8, in a scale from 0 (no functional impairment) to 10 (the functional impairment when the patient arrive to our consultation); the second month was 6; the 3rd, 3, the 4th month.
In this patient is relevant not only the insomnia and pain rebellious to other pharmacological treatments released by acupuncture but the recovery of functional impairment with an electrophysiological study which verifies severe lesion on right brachial plexus.
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