Background There is no effective treatment for intractable postherpeticneuralgia. Because there is evidence that postherpetic neuralgiahas an inflammatory component, we assessed treatment with intrathecallyadministered methylprednisolone to reduce pain in patients withthis disorder.
Methods We enrolled 277 patients who had had intractable postherpeticneuralgia for at least one year, 270 of whom were followed fortwo years. The patients were randomly assigned to receive intrathecalmethylprednisolone and lidocaine (3 ml of 3 percent lidocainewith 60 mg of methylprednisolone acetate, 89 patients), lidocainealone (3 ml of 3 percent lidocaine, 91 patients), or no treatment(90 patients) once per week for up to four weeks. Each weeklydose was injected into the lumbar intrathecal space. Pain wasevaluated before randomization, at the end of the treatmentperiod, and then four weeks, one year, and two years later.Samples of cerebrospinal fluid were obtained for measurementof interleukin-8 before and at the end of the treatment period.
Results There was minimal change in the degree of pain in thelidocaine-only and control groups during and after the treatmentperiod. In the methylprednisolone–lidocaine group, theintensity and area of pain decreased, and the use of the nonsteroidalantiinflammatory drug diclofenac declined by more than 70 percentfour weeks after the end of treatment. No complications relatedto intrathecal methylprednisolone were observed. Before treatment,the concentrations of interleukin-8 in the cerebrospinal fluidwere inversely related to the duration of neuralgia in all thepatients (r=–0.49, P<0.001). In the patients who receivedmethylprednisolone, interleukin-8 concentrations decreased by50 percent, and this decrease correlated with the duration ofneuralgia and with the extent of global pain relief (P<0.001for both comparisons).
Conclusions The results of this trial indicate that the intrathecaladministration of methylprednisolone is an effective treatmentfor postherpetic neuralgia.
Source Information
From the Outcomes Research Group, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan.
Address reprint requests to Dr. Kotani at the Department of Anesthesiology, University of Hirosaki School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan.
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