[Postherpetic neuralgia of the left trigeminus nerve V1 : Successful therapy with capsaicin 8% patch].

Abstract

A 68-year-old patient suffered from postzoster neuralgia with severe pain of the left trigeminal nerve V1. Despite medication with gabapentin 1800 mg/d, oxacarbazepine 600 mg, tapentadol 500 mg/d, amitriptyline 20 mg as well as ambroxol 20% ointment and lidocaine patch topically, the pain reached an intensity of 8-10 on the numeric rating scale (NRS). Wearing a CPAP (continuous positive airway pressure) mask at night to treat a sleep apnea was impossible or the mask was leaking under lidocaine patch, only topical ambroxol 20% brought a certain pain relief. Lack of sleep, a strongly reduced quality of life and massive exhaustion followed quickly. Due to a fall the systemic medication could not be increased. Also lidocaine infusions with dexamethasone and supraorbitalis blockades were unsuccessful, and a ganglionic local opioid analgesia (GLOA) was anatomically not feasible. Therefore, 8 weeks after the onset of the disease, treatment with capsaicin 8% for 60 min on the face was performed. After only one week, 20-30% pain relief was achieved, sometimes even freedom from pain. Six weeks after application, the average pain during the day was only NRS 3/10 despite a considerable reduction in oral medication. Three months after the second treatment, the patient was almost pain-free during the day. Topical capsaicin 8% patch is, in our opinion, also safe and successful to use on the face with appropriate experience of the user.

• Authors: K-U Kern, M Schwickert-Nieswandt
• Journal: Schmerz (Berlin, Germany) (Schmerz) Vol. 32 Issue 6 Pg. 464-467 (Dec 2018) ISSN: 1432-2129 [Electronic] Germany
• Vernacular Title: Post-Zoster-Neuralgie des linken Trigeminusastes V1 : Erfolgreiche Therapie mit Capsaicin 8 %‑Pflaster.
• PMID: 30306307 (Publication Type: Case Reports, Journal Article)

Chemical References

• Lidocaine
• Capsaicin

Topics

• Aged
• Capsaicin
• Humans
• Lidocaine
• Neuralgia, Postherpetic
• Quality of Life
• Trigeminal Nerve