Background: The most common complication of herpes zoster is POSTHERPETIC NEURALGIA (PHN), which can cause chronic and debilitating pain. In some patients, pain persists for weeks or even years after regression of the rash and many drugs and methods should be used to treat the pain. As many patients are elder and suffer from chronic diseases, they would be affected by drug complications. Recently, subcutaneous injection of botulinum toxin is used as a new method for controlling pain with little complications. There are a few case studies about effect of botulinum toxin injection to relieve pain. We assessed the effect of subcutaneous injection of botulinum toxin on relieving pain in POSTHERPETIC NEURALGIA.Methods: In this intervention study, 15 patients suffer POSTHERPETIC NEURALGIA were enrolled by convincing sampling method. Information as age, sex, dermatome, place and duration of pain, and severity of pain were registered in patients. Then botulinum toxin injected 15 units per 10 cm² subcutaneously. Patients were followed in 2nd day, 2nd week, and 4th week after injection and pain was measured by visual analog score (VAS). Data were analyzed by Repeated Measure ANOVA test using SPSS16 software.Finding: Six patients were male and 9 were female. The mean age was 60±4.5 year and duration of pain was 6.5 month. Mean of VAS in 2nd day, 2nd week, and 4th week were 6.4, 7.2, and 7.6 respectively. Patients’ pain in 4th week were decreased compare with before injection but the difference was not statistically significant (P=0.06).Conclusion: It seemed that subcutaneously injection of botulinum toxin can relieve pain in POSTHERPETIC NEURALGIA. Hence this decrease in duration of the time was observed to be lesser, repetition of injection could be more effective for controlling the pain.

Introduction: Herpes zoster (HZ), also known as shingles, is caused by the reactivation of the varicella-zoster virus (VZV). There have been several reports of HZ associated with COVID-19 vaccination, and the outcomes have varied. Case Presentation: In this report, we present 4 cases of patients who experienced HZ reactivation after receiving a COVID-19 vaccine. These individuals sought treatment at a pain management center due to POSTHERPETIC NEURALGIA (PHN). While HZ itself can be treated, post-herpetic NEURALGIA can persist for years, significantly impacting the patients’ quality of life. Therefore, early recognition of this adverse effect is crucial, and patients should receive specialized analgesic support promptly to prevent the development of chronic pain.

Background: We aimed to study the curative effects of botulinum A toxin (BTX-A) on the treatment of post-herpetic NEURALGIA (PNH).Methods: We enrolled 58 PNH patients and treated them with hypodermic injection of BTX-A in Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei, China. We measured and compared the Visual Analog Score (VAS), Neuropathy Pain Scale (NPS), Quality of Life Scale (SF-36) score, PNH seizure severity degree, seizure dura-tion, frequency of attack and the use of painkillers before and after treatment. We used SPSS13 software package for statistical analysis. Values were expressed by mean ± standard deviation. P<0.05 indicated a significant difference and P<0.01 indicated an obvious significant difference.Results: Attack frequency, attack duration and attack severity were all significantly lower after treatment (P<0.01). The use of painkillers reduced after treatment (P<0.01) and we observed very few adverse reactions associated with BTX-A injection.Conclusion: The use of BTX-A for treating post-herpetic NEURALGIA produced very promising results with very few adverse reactions. BTX-A can be considered as a valid approach in the treatment of PNH, especially in patients that do not respond well to painkillers.

Background: Neuropathic pain results from injury to or dysfunction of the central or peripheral nervous system. Diabetic peripheral neuropathy, post-herpetic NEURALGIA, and trigeminal NEURALGIA are among the most common types of neuropathic pain. Patients with these types of pain usually suffer from localized symptoms such as constant or intermittent paresthesia, tingling, burning sensation or spontaneous pain. Neuropathic pain is an unpleasant sensation and experience that could adversely affect the quality of life of patients. They often responds to treatment with difficulty and based on the current treatments, only 40 to 60% of patients with neuropathic pain achieve partial relief. Antidepressants (tricyclics and serotoninnorepinephrine reuptake inhibitors), ligand of calcium channelα2-δ subunits (gabapentin and pregabalin) and topical lidocaine have been considered as the first-line therapy for neuropathic pain. Opioid analgrsics and tramadol are generally recommended as the secondline therapy. Other agents such as antiepileptics (e.g. carbamazepine), antagonists of N-Methyl-D-aspartate receptor (e.g. memantine, dextromethorpham), and topical capsaicin have been mainly classified as the third-line treatment for neuropathic pain. Due to the importance of neuropathic pain, reviewing its novel nonpharmacological and pharmacological modalities seems necessary.

Background: Pain and pruritus are two common symptoms in dermatology that are transmitted with unmyelinated C fibers via substance P. Topical capsaicin is effective due to depletion of nerve endings from substance P. Objective: The efficacy and side effects of capsaicin gel in painful and pruritic skin disorders was compared to placebo. Patients & Methods: In a controlled clinical trial, 40 patients (21 patients with POSTHERPETIC NEURALGIA, 10 with lichen simplex chronicus, and 9 with notalgia paresthetica), with the mean age of 48 years were randomly treated with 0.075% capsaicin gel or placebo q.i.d. for 4 weeks. The severity of symptoms and side effects were assessed every two weeks and recurrence was assessed also two months after treatment. Results: 31 cases (77%) completed their 4 weeks treatment period. According to Visual Analogue Score system, the mean of symptom severity decreased from 7.6 (±2.4) before treatment to 0.9 (±0.9) after treatment in capsaicin group and decreased from 6.3 (±2.3) to 5.0 (P<0.05). (±3.2) in placebo group Conclusion: Capsaicin gel is effective in painful and pruritic skin disorders and has tolerable side effects..

Introduction: POSTHERPETIC NEURALGIA (PHN) is a frequently occurring neuropathic pain, its pathophysiology is not fully understood. There are only few evidence based therapeutic options; sympathetic nerve block can be considered for patients with PHN refractory to conservative treatment, but long-term effects are poor. Application of pulsed radiofrequency was effective to treat a variety of pain syndromes without neurological complications or other sequelae.Case Presentation: We observed a remarkable long-lasting pain relief in patients with post herpetic NEURALGIA (PHN) treated with caudal epidural PRF. We described the technique of caudal epidural PRF and three case reports.Conclusions: The mode of action of PRF is far from being completely elucidated. The high frequency current induces an electric field that in turn seems to influence the immunity, the inflammation and other pain conducting mechanisms. Our findings suggest an effect distal from the application of the current. It reaches targets that are difficultly attainable by any other means of current application. The observations of pain relief in the difficult to treat patients with PHN justifies further investigation.