Relief of post-herpetic neuralgia by surgical removal of painful skin

We present a case of longstanding PHN treated by skin excision of the area of greatest pain (11.3×26.0 cm 2). The operation reduced pain, eliminated tactile allodynia, and facilitated greatly reduced medication use over a 1-year follow-up period. Fourteen punch biopsies and 10 strips of skin (each 1...

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Bibliographic Details
Published in:	Pain (Amsterdam) Vol. 98; no. 1; pp. 119 - 126
Main Authors:	Petersen, Karin L, Rice, Frank L, Suess, Fred, Berro, Marlene, Rowbotham, Michael C
Format:	Journal Article
Language:	English
Published:	Amsterdam Elsevier B.V 01-07-2002 Elsevier
Subjects:	Aged Allodynia Biological and medical sciences Biopsy Calcitonin Gene-Related Peptide - metabolism Capsaicin Cranial nerves. Peripheral nerves. Autonomic nervous system Dermatologic Surgical Procedures Herpes Zoster - complications Humans Hyperalgesia Hyperesthesia - etiology Hyperesthesia - physiopathology Male Medical sciences Neuralgia - complications Neuralgia - physiopathology Neuralgia - surgery Neuralgia - virology Neurofilament Proteins - metabolism Neurosurgery Nociceptors Pain - physiopathology Palliative Care Receptors, Drug - metabolism Skin - pathology Skin - physiopathology Skin biopsy Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Thiolester Hydrolases - metabolism Touch Ubiquitin Thiolesterase VR-1 Allodynia Nociceptors Skin biopsy VR-1 Capsaicin Hyperalgesia Peripheral nervous system Human Calcitonin gene related peptide Post-herpetic neuralgia Nociceptor Treatment Biopsy Surgery Sensitive nerve fiber Skin Vanilloid receptor
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Summary:	We present a case of longstanding PHN treated by skin excision of the area of greatest pain (11.3×26.0 cm 2). The operation reduced pain, eliminated tactile allodynia, and facilitated greatly reduced medication use over a 1-year follow-up period. Fourteen punch biopsies and 10 strips of skin (each 10 mm long) from the excised painful PHN skin were qualitatively assessed by double-label immunofluorescence using antibodies against protein-gene-product 9.5 (PGP9.5), 200 kDa neurofilament protein (NF), calcitonin gene-related peptide (CGRP) and vanilloid receptor-1 (VR-1). Comared with a punch biopsy from mirror image skin, the pattern of cutaneous innervation in PHN skin was consistently and substantially different. The results may explain the anatomical basis of the capsaicin-response test and have implications for our understanding of clinical mechanisms underlying PHN pain.
Bibliography:	ObjectType-Case Study-3 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-2
ISSN:	0304-3959 1872-6623
DOI:	10.1016/S0304-3959(02)00029-5