Shingles (herpes zoster) is a painful, blistering rash caused by the chickenpox virus. Chronic pain is the most frequent complication of shingles. In their clinical trial Albert van Wijck, Wim Opstelten (University Medical Center Utrecht, Netherlands) and colleagues randomly assigned 598 shingles patients to standard therapy (oral antivirals and analgesics) or standard therapy with one additional epidural injection of steroids (methylprednisolone) and local anaesthetics (bupivacaine). The investigators found that up to 1 month after inclusion, the number of patients reporting pain was reduced in the epidural group. However, the effect of the epidural was strongest during the first week and did not last beyond one month.
Dr van Wijck comments: "We conclude that one epidural injection of methylprednisolone and bupivacaine, applied in the acute phase of herpes zoster, has a modest effect in reducing zoster-associated pain for 1 month. However, because this treatment did not prevent long-term postherpetic neuralgia, we suggest that an epidural injection of corticosteroid and bupivacaine only be considered for patients with severe acute pain from herpes zoster who are not responding to standard analgesic therapy."
See also accompanying Comment.
Contact: Dr Albert J.M. van Wijck, Pain Clinic, HP L02.502, Department of Anaesthesiology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands. T)31-30-250-6163, a.vanwijck@umcutrecht.nl
The Lancet