| |
|
|
ABSTRACT
5
COMBINED
ALLOPATHIC
AND ACUPUNCTURE MANAGEMENT
OF POST-HERPETIC NEURALGIA
OF SACRAL DISTRIBUTION
By
M. Truett Bridges, Jr. M.D.,
Medical Acupuncture/Pain Managernent/Holistic Medicine,
Atlanta, Georgia
EDUCATIONAL OBJECTIVE
Present a multi-modal approach to a historically
difficult pain problem.
PROBLEM
Post-operative outbreak of Herpes zoster,
with persistent and worsening pain after healing of lesions.
CHIEF COMPLAINT
"There is pain where the lesions are,
but it's even worse at the perineum and penis. 1 can't sit down."
HISTORY OF PRESENT
ILLNESS
This 66-year-old white male had surgery
for colon cancer in early October, 1997. It was felt to be a curative
surgery, and the post-operative course was unremarkable. One-to-two
weeks after the surgery, he developed acute Herpes zoster. This
produced typical lesions down the back of the left thigh in the
S 2 distribution. Mildly to moderately uncomfortable, he was treated
with valacyclovir (Valtrex), and the acute lesions quickly resolved.
About 6 weeks later, he developed a burning
pain in the area of the lesions, a similar pain in the penis and
perineum, and a pain he described as a dull sensation in the perineal/scrotal
region persisted. This was quite distressing to him as it interfered
with sleep, sexual activity, and made it impossible to sit for
more than a few minutes, including driving.
He was advised to use ibuprofen for the
pain; this would be a self-limiting condition that would last
for "6 weeks to a year."
PAST HISTORY
Mild benign prostatic hypertrophy, with
some frequency and nocturia. Patient was treated with antibiotics,
although he says there was no bacteriuria a. He was treated with
glyburide (Micronase) for Type 11 diabetes.
FAMILY / SOCIAL
HISTORY
Married, retired accountant, frequent
traveler.
MEDICATIONS /
SUPPLEMENTS
Pharmaceuticals as above; Saw Palmetto
for BPH.
ALLERGIES
NKDA
REVIEW OF SYSTEMS
History of anxiety; quick-tempered; prone
to explosive outbursts in traffic, or waiting.
PHYSICAL EXAM
This cheerful, gray-haired white male
grimaced when sitting down, and frequently shifted from side-to-side
while sitting. There was a dry, healed and scarring, roughly linear
lesion following the S 2 distribution up the posterior left thigh.
There were a few, small healed lesions over the upper left buttock.
No lesions were noted at the perineum or on the penis. The lesions
were not tender to palpation.
Pulses were decreased at the middle Yin
positions (Liver, Spleen). Tongue was reddish, with reddened edges
and Spleen cracks; minimal coating. Facial cast was somewhat greenish.
DIAGNOSIS
Post-herpetic neuralgia in the S
2 and S 3 distribution. Disharmony in Liver (genital pain); cutaneous
manifestation of Heat.
TREATMENT
Treatment was eclectic, utilizing a pharmacologic
agent, neuroanatomic electro-acupuncture, TCM, and French Energetic
models. The man was treated 3 times, over an 8 -day period. At
the first visit, amitriptyline, 10 mg at bedtime, was prescribed.
He was cautioned to call if there was any increase in his urinary
outflow symptoms, bearing in mind the anticholinergic effect of
this agent. This did not occur, and the dose was increased to
25 mg after about 5 days.
Acupuncture treatment focused on Jue
Yin/Shao Yang circuits, especially, points on the Liver Meridian
to affect the genital area. Lung and Liver points were also chosen
to affect the skin. Electro-acupuncture at the sacral level, and
near the thigh lesions, was done. On the last treatment, the Curious
Meridians, Dai Mo and Ren Mo, were activated. Sessions were approximately
I hour.
Needles: 34g to 36g, I to 2.0 inches.
OUTCOME / OBJECTIVE
By the third treatment, the patient
was able to lie prone, without pillows to raise the penis.
OUTCOME / SUBJECTIVE
After one treatment, he claimed a 5 -
10% reduction in pain. Although he had previously been ambivalent
about acupuncture, after the second treatment, he felt it was
working. He scheduled I more session prior to leaving for a previously-planned
sea cruise
The patient called 3 weeks later,
after returning from his trip. He reported a 95- 100% reduction
in pain. He had been able to drive for 7-8 hours to their port
of departure without pain. There was no worsening of his urinary
symptoms.
No complications were reported.
FOR ADDITIONAL
READING
1. Lewith, GT, et al. Acupuncture compared with placebo in post-herpetic
pain. Pain, December, 1983; 17(4):361-368.
2.Volmink, J, et al. Treatments for post-herpetic neuralgia: a
systematic review of randomized controlled trials. Family Practice,
February, 1996; 13(l):84-91.
AUTHOR INFORMATION
Dr. M. Truett Bridges, Jr. specializes in Medical Acupuncture,
Pain Management, and Holistic Medicine in Atlanta, Georgia. His
affiliations include Diplomate, American Board of Anesthesiology;
member, American Academy of Medical Acupuncture.
M. Truett Bridges,
Jr., M.D.
4920 Roswell Road, Suite 36
Atlanta, GA 30342
Phone: 404-843-3400 Fax: 404-843-8101 Email:
TruettB@mindspring.com
NEXT
ABSTRACT >
Back
to Top AAMA
Table
of Contents Journal
Index
|
|
|
|