Skip to main content

Advertisement

SpringerLink
Log in

Clinical efficacy of transforaminal epidural injection for management of zoster-associated pain: a retrospective analysis

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objectives

Transforaminal epidural injection (TFEI) has superior accessibility to the dorsal root ganglion, which is an essential location of pain signaling in herpes zoster. However, the effectiveness of TFEI for herpes zoster patients has not previously been studied. We retrospectively analyzed the efficacy of TFEI for pain control and prevention of PHN in patients with acute and subacute herpes zoster.

Methods

Medical records of 137 patients who underwent TFEI for zoster-associated pain (ZAP) were reviewed. The participants were divided into two groups: acute TFEI group (TFEI within 30 days after zoster) and subacute TEEI group (TFEI between 30 and 90 days). The efficacy of TFEI was assessed by a numerical rating scale (NRS), doses of medications, and time to relief of ZAP. Incidence of PHN at 1 week to 6 months after TFEI was evaluated.

Results

Time to ZAP relief was significantly shorter and the incidence of PHN was significantly lower in the acute TFEI group than in the subacute TFEI group. Rate of medication discontinuation was significantly higher in the acute TFEI group than in the subacute TFEI group.

Conclusions

Early application of TFEI in the acute phase of zoster can be a useful option for ZAP control and prevention of chronic neuropathic pain such as PHN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Gauthier A, Breuer J, Carrington D, Martin M, Rémy V. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2009;137:38–47.

  2. Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LSA. Population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007;82:1341–9.

    Article  PubMed  Google Scholar 

  3. Forbes HJ, Thomas SL, Smeeth L, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016;157:30–54.

    Article  PubMed  Google Scholar 

  4. Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain. 2008;9:S37–44.

    Article  PubMed  Google Scholar 

  5. Jeon YH. Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment. Korean J Pain. 2015;28:177–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Pasqualucci A, Pasqualucci V, Galla F, et al. Prevention of postherpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone. Acta Anaesthesiol Scand. 2000;44:910–8.

    Article  CAS  PubMed  Google Scholar 

  7. vanWijck AJ, Opstelten W, Moons KG, et al. The PINE study of epidural steroids and local anaesthetics to prevent postherpetic neuralgia: a randomized controlled trial. Lancet. 2006;367:219–24.

    Article  CAS  Google Scholar 

  8. Ji G, Niu J, Shi Y, Hou L, Lu Y, Xiong L. The effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of postherpetic neuralgia in patients with acute herpes zoster. Anesth Analg. 2009;109:1651–5.

    Article  CAS  PubMed  Google Scholar 

  9. Makharita MY, Amr YM, El-Bayoumy Y. Single paravertebral injection for acute thoracic herpes zoster: a randomized controlled trial. Pain Pract. 2015;15:229–35.

    Article  PubMed  Google Scholar 

  10. Reichelt M, Zerboni L, Arvin AM. Mechanisms of varicella zoster virus neuropathogenes is in human dorsal root ganglia. J Virol. 2008;82:3971–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Esiri MM, Tomlinson AH. Herpes zoster. Demonstration of virus in trigeminal nerve and ganglion by immunofluorescence and electron microscopy. J Neurol Sci. 1972;15:35–48.

    Article  CAS  PubMed  Google Scholar 

  12. Oaklander AL. Mechanisms of pain and itch caused by herpes zoster (shingles). J Pain. 2008;9:s10–8.

    Article  PubMed  Google Scholar 

  13. Gupta R, Singh S, Kaur S, Singh K, Aujla K. Correlation between epidurographic contrast flow patterns and clinical effectiveness in chronic lumbar discogenic radicular pain treated with epidural steroid injections via different approaches. Korean J Pain. 2014;27:353–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kim ED, Roh MS, Park JJ, Jo D. Comparison of the ventral epidural spreading in modified interlaminar approach and transforaminal approach: a randomized, double-blind study. Pain Med. 2016;17:1620–7.

    Article  PubMed  Google Scholar 

  15. Shakir A, Kimbrough DA, Mehta B. Postherpetic neuralgia involving the right C5 dermatome treated with a cervical transforaminal epidural steroid injection: a case report. Arch Phys Med Rehabil. 2007;88:255–8.

    Article  PubMed  Google Scholar 

  16. Conliffe TD, Dholakia M, Broyer Z. Herpes zoster radiculopathy treated with fluoroscopically-guided selective nerve root injection. Pain Physician. 2009;12:851–3.

    PubMed  Google Scholar 

  17. Mehta P, Maher P, Singh JR. Treatment of postherpetic neuralgia using a thoracic transforaminal epidural steroid injection. PMR. 2015;7:443–6.

    Article  Google Scholar 

  18. Coplan PM, Schmader K, Nikas A, et al. Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: adaptation of the brief pain inventory. J Pain. 2004;5:344–56.

    Article  PubMed  Google Scholar 

  19. Lydick E, Epstein RS, Himmelberger D, White CJ. Herpes zoster and quality of life: a self-limited disease with severe impact. Neurology. 1995;45:S52–3.

    Article  CAS  PubMed  Google Scholar 

  20. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352:2271–84.

    Article  CAS  PubMed  Google Scholar 

  21. Liu SS, Melmed AP, Klos JW, Innis CA. Prospective experience with a 20-gauge Tuohy needle for lumbar epidural steroid injections: is confirmation with fluoroscopy necessary? Reg Anesth Pain Med. 2001;26:143–6.

    CAS  PubMed  Google Scholar 

  22. Makharita YM, Amr MY, El-Bayoumy Y. Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia. Pain Physician. 2012;15:467–74.

    PubMed  Google Scholar 

  23. Dworkin RH, O’Connor AB, Kent J, et al. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain. 2013;154:2249–61.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Murthy NS, Maus TP, Behrns CL. Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz). A retrospective review. Pain Med. 2010;11:1756–64.

    Article  PubMed  Google Scholar 

  25. Park KD, Lee J, Jee H, Park Y. Kambin triangle versus the supraneural approach for the treatment of lumbar radicular pain. Am J Phys Med Rehabil. 2012;91:1039–50.

    Article  PubMed  Google Scholar 

  26. Sullivan WJ, Willick SE, Chira-Adisai W, et al. Incidence of intravascular uptake in lumbar spinal injection procedures. Spine. 2000;25:481–6.

    Article  CAS  PubMed  Google Scholar 

  27. Kim YH, Park HJ, Moon DE. Rates of lumbosacral transforaminal injections interpreted as intravascular: fluoroscopy alone or with digital subtraction. Anaesthesia. 2013;68:1120–3.

    Article  CAS  PubMed  Google Scholar 

  28. El Abd OH, Amadera JE, Pimentel DC, Pimentel TS. Intravascular flow detection during transforaminal epidural injections: a prospective assessment. Pain Physician. 2014;17:21–7.

    PubMed  Google Scholar 

  29. Nahm FS, Lee CJ, Lee SH, et al. Risk of intravascular injection in transforaminal epidural injections. Anaesthesia. 2010;65:917–21.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Eung Don Kim, Ha Hyeon Bak & Dae Hyun Jo

  2. Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, 137-701, Seoul, Republic of Korea

    Hue Jung Park

Authors
  1. Eung Don Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ha Hyeon Bak
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dae Hyun Jo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hue Jung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hue Jung Park.

Ethics declarations

Conflict of interest

The authors have no funding and conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, E.D., Bak, H.H., Jo, D.H. et al. Clinical efficacy of transforaminal epidural injection for management of zoster-associated pain: a retrospective analysis. Skeletal Radiol 47, 253–260 (2018). https://doi.org/10.1007/s00256-017-2795-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2795-2

Keywords

Search

Navigation