• Honorio T Benzon, Kiran Chekka, Amit Darnule, Brian Chung, Oscar Wille, and Khalid Malik.
• Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. hbenzon@nmff.org
• Reg Anesth Pain Med. 2009 Sep 1;34(5):514-21.

ObjectiveA patient with postherpetic neuralgia (PHN) did not respond to medications, either singly or in combination, or to intrathecal methylprednisolone but responded to intrathecal alcohol. This evidenced-based case management article evaluates and grades the evidence for the prevention and treatment of PHN.MethodsA search of published English-language studies on the prevention and treatment of PHN was made.ResultsRandomized clinical studies showed the efficacy of antiviral agents in the prevention of PHN and the use of anticonvulsants, antidepressants, opioids, and Lidoderm patch in the treatment of PHN (level A evidence). The role of epidural local anesthetic and steroid injections in preventing PHN has not been completely established (level B evidence). Intrathecal steroid injections and topical capsaicin may be effective in PHN (level B evidence). No randomized controlled study supports the usefulness of spinal cord stimulation and intrathecal alcohol.ConclusionsPostherpetic neuralgia should be managed pharmacologically. If not effective, intrathecal steroid injections or nerve blocks may be tried. Spinal cord stimulation or intrathecal alcohol should be used only as a last resort.

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