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Parameters associated with efficacy of epidural steroid injections in the management of postherpetic neuralgia: the Mayo Clinic experience

Authors Ghanavatian S, Wie CS, Low RS, Butterfield RJ, Zhang N, Dhaliwal GS, Montoya JM, Swanson DL

Received 12 October 2018

Accepted for publication 18 February 2019

Published 23 April 2019 Volume 2019:12 Pages 1279—1286

DOI https://doi.org/10.2147/JPR.S190646

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr E Alfonso Romero-Sandoval


Shirin Ghanavatian,1 Christopher S Wie,2 Rhonda S Low,3 Richard J Butterfield,4 Nan Zhang,4 Gurman Singh Dhaliwal,5 Jordan M Montoya,6 David L Swanson1

1Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA; 2Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA; 3Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Scottsdale, AZ, USA; 4Biostatistics, Mayo Clinic, Scottsdale, AZ, USA; 5University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA; 6Mayo Clinic School of Medicine, Scottsdale, AZ, USA

Purpose: Thirty percent of patients with postherpetic neuralgia (PHN) receiving conservative treatment report unsatisfactory pain relief. Epidural steroid injections (ESIs) are commonly used as a therapeutic intervention in these patients. In this study, we aimed to determine if there are variables that predict the efficacy of ESI in patients with PHN.
Patients and methods: We retrospectively identified patients seen at Mayo Clinic who had PHN and received ESI. From their medical records, we abstracted the demographic variables, concurrent medication use, anatomic approach and medication for ESI, and degree of pain relief at 2 and 12 weeks’ postintervention.
Results: None of the studied variables were significantly associated with efficacy of ESI in patients with PHN. PHN that began <11 months before treatment was predictive of a response to ESI at 12 weeks postintervention (positive predictive value, 55%). Patients who reported poor ESI efficacy 2 weeks after the intervention had a 94% chance of still having pain at 12 weeks. 
Conclusion: For this cohort of patients with PHN being treated with ESI, no demographic characteristics, concurrently used medications, or type of ESI were associated with ESI treatment efficacy at 2 or 12 weeks after the intervention.

Keywords: herpes zoster, intervention, neuropathy


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