Nerve Block For Shingles Pain

What Will I Experience During The Procedure

The pain specialist will administer a local anesthetic before injecting the nerve block.

This procedure involves inserting a thin needle directly into the area where the nerves are located. The doctor may also use imaging aids so they can administer the nerve block as efficiently and quickly as possible.

You will feel a âpinchâ and a minor discomfort when the needle enters your skin. However, normally the fear of the procedure is worse than the procedure itself. The level of discomfort depends on how deep the needle is inserted.

How Effective Are Nerve Blocks In Treating Shingles Pain

Nerve block therapy is one of the safest and most effective strategies to treat shingles pain. The effects vary from patient to patient and depend on the type of nerve block.

Nevertheless, remember your doctor must analyze your case before deciding which is the best treatment for you. At our pain center, one of our specialists will create a comprehensive pain management plan for you depending on your personal needs.

Is An Intercostal Nerve Block Right For You

An intercostal nerve block may be right for you if you have a recent onset of pain in the chest area especially due to shingles or a surgical incision which does not respond to other treatment.

Talk to your physician about it. To schedule an evaluation at Cleveland Clinics Department of Pain Management call 216.444.PAIN or 800.392.3353.

Reviewed by a Cleveland Clinic medical professional.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

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How Does An Intercostal Nerve Block Work

The procedure helps relieve pain by injecting a local pain reliever and a steroid into the area. The injection is made with a needle inserted between two ribs to release a steroid into the area around the nerve causing the pain. The exact location of the injection depends on the underlying cause and location of the injury.

Every patient responds differently to the nerve block. Generally, the steroid begins working in three to five days and can last several days or several months.

Other Sources Of Intercostal Pain

Neuralgia or nerve pain isnt the only source of rib pain. Rib pain can be caused by traumatic events like a car accident or a fall down the stairs, but it can also occur after a relatively mundane experience, such as stretching after waking up, coughing too hard, or turning too fast. In the case of severe pain following a sprain or fracture, a nerve block may still be recommended as an alternative to medication.

Intercostal muscle strains can cause pain and problems with deep breathing and even lead to bruising or swelling. If you are experiencing rib pain for more than a few hours, contact your doctor. If your pain symptoms are accompanied by fever or nausea, seek immediate medical help.

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Other Treatments For Intercostal Pain

Aside from nerve blocks, rib pain is also addressed through topical treatments.

• Lidocaine or Capsaicin
• Over-the-counter pain medication
• Antidepressants and anticonvulsants

In severe cases of rib pain, nerve-related or otherwise, surgery may become necessary. Some hospitals also offer a neurectomy, or the removal of a nerve, as a long-term solution for severe intercostal pain in cases where all other more conservative measures didnt work. Surgery is almost always the last resort when nothing else is helping.

Pain can be difficult to address. There are many different modalities for effecting change in a patients condition. Theres never a guarantee that one will work. Be sure to go over all available options with your doctor, and properly weigh the personal pros and cons together.

How Are Nerve Blocks Used

There are different kinds of nerve blocks used for various purposes.

• Therapeutic nerve blocks are used to treat painful conditions. Such nerve blocks contain local anesthetic that can be used to control acute pain.
• Diagnostic nerve blocks are used to determine sources of pain. These blocks typically contain an anesthetic with a known duration of relief.
• Prognostic nerve blocks predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments would be successful in treating pain.
• Preemptive nerve blocks are meant to prevent subsequent pain from a procedure that can cause problems including phantom limb pain.
• Nerve blocks can be used, in some cases, to avoid surgery.

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Rebooting The Nervous System

Its like restarting a computer, Dr. Rosenquist says. When its running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully, it will send an appropriate transmission as opposed to a pain transmission.

Treatmentoptions for PHN patients include:

Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.

Facts About Shingles Pain

DurationAfter shingles go away, the blisters can remain for several weeks. In most cases, the pain lasts for about a month. We consider you have PHN if the pain lasts for over 2 months.

Postherpetic painPHN is caused by residual stimulation of the nerves. Without treatment, shingles pain can last for weeks, months, and even years.

TreatmentsOptions include nerve blocksâinjecting a local anestheticâ, and thoracic epidural injectionsâan anti-inflammatory medicine.

Also Check: What Foods Not To Eat With Shingles

Antiviral Treatment For Preventing Nerve Pain After Shingles

Review question

We reviewed the evidence about the effect of antiviral medicines for preventing postherpetic neuralgia .

Background

PHN is a painful condition that can occur after shingles in the area where the rash occurred. Many people with PHN find that treatments work only a little or not at all. Attention has therefore turned to stopping the development of PHN. Some people suggested that medicines that target the virus that causes shingles , given at the time of the rash, might prevent PHN. The aim of this review was to assess the whether antiviral medicines are able to prevent PHN.

Study characteristics

We identified six clinical trials that met our standards for inclusion in the review. They included a total of 1319 participants. We decided that our main measure of whether antiviral medicines work in preventing PHN would be whether or not PHN had developed six months after a first attack of shingles .

Key results and quality of the evidence

The evidence is current to April 2013, when the searches were last updated. Because new evidence on this topic is slow to emerge, we have scheduled the next update of this review for 2017.

Am I A Good Candidate For Nerve Blocks

People whoâve had pain for several months and havenât responded to traditional therapies are usually good candidates for nerve blocks.

Nevertheless, you should inform your doctor if you are allergic to any medication if you are pregnant, have an active infection, have diabetes or heart disease, or if you are taking blood-thinning medication.

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Shingles & Postherpetic Neuralgia

It stays dormant for decades, waiting for the right time to reactivate or awaken. When the virus wakes up, it will spread along and within the closest major nerve to its sleeping place causing a painful condition we call shingles. Shingles usually begins with fever and headache, accompanied by itchiness and oversensitivity in a distinct and limited area of your skin. This resolves into a characteristic stripe, or belt like rash in which small blisters form. The pain can be intense and even last for years after the rash disappears, a condition referred to as postherpetic neuralgia . PHN is notoriously difficult to treat, so choosing the right pain management doctor is crucial.

At the Ainsworth Institute of Pain Management, we are uniquely trained and specialized in treating shingles and PHN. Our board certified pain management specialists can offer a combination of treatment options, many not available anywhere else.

What causes the varicella zoster virus to reactivate is not fully understood. It is known, however, that shingles are likely to appear when someones immune system is impaired, either by age, disease or psychological stress.

The Details: Heres Where Postherpetic Neuralgia Gets Complicated

Postherpetic Neuralgia Causes

To help you understand how shingles can cause PHN, you need to know how you can get shingles. Shingles is caused by a viral infection called herpes zoster. The virus that causes herpes zoster is called the varicella-zoster virus, and it is the same virus that causes chicken pox in childhood. After a person recovers from chickenpox, the virus can enter the nervous system and remain dormant for many years. In some people, the virus will reactivate years later and produce shingles.4

Researchers arent exactly sure what triggers the herpes zoster virus to re-emerge after all those years, but they think it is related to age, illness, and stress.3 Shingles can be very painful, and when the virus reaches the skin, it can cause blistery rashes. These rashes usually heal in less than 3 months.

And this chain of events can lead to PHN. If the pain of shingles lingers longer than 3 months, you may have PHN.

During your bout with shingles, the virus you were fighting injured nerves in and around the skin where the rash and blisters once existed. As your immune system eventually suppressed the virus, your rash and blisters disappeared. You may have even felt less pain, and you assumed that you had won the battle with shingles.

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Shingles And Your Eyes

If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.

Shingles painand other symptoms from an outbreak of herpes zosterusually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, its called postherpetic neuralgia .

Phn At 3 6 And 12 Months After The Onset Of The Herpes Zoster

We performed a meta-analysis in order to combine the relevant data obtained by the 9 included trials. The results show that PHN incidence following nerve block application was significantly reduced in comparison with standard treatment alone at 3, 6, and 12 months after the onset of herpes zoster . To reduce heterogeneity, we performed a subgroup analysis according to the type of nerve block administered at 3 months after herpes zoster was diagnosed. PHN incidence was not reduced by administering stellate ganglion block or a single epidural block . However, PHN incidence was significantly reduced by administering continuous/ repeated epidural blocks and paravertebral blocks . According to the subsequent meta-analysis of the differences between administering single or repeated/continuous blocks, PHN incidence was significantly reduced by administering repeated/continuous block but not a single block in comparison with standard therapy alone .

Effects of nerve blocks on the incidence of postherpetic neuralgia. The incidence of postherpetic neuralgia was significantly lowered in nerve block treatment compared with control standard treatment at 3, 6 and 12 months after the onset of herpetic skin rash, but heterogeneity among trials was high.Comparison of single block versus repeated/continuous blocks on the incidence of postherpetic neuralgia. The incidence of postherpetic neuralgia was lowered by repeated/continuous blocks, but not single block.

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Help Is Available For Phn

Fortunately,early treatment for shingles can lower your chances of getting PHN.

For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.

Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.

However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.

Are There Other Ways To Ease The Pain

Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include:

TENS : You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.

Cold packs: Try a gel-filled one to numb the area unless cooler objects make your neuralgia worse.

Comfortable clothes: Go for looser fits and fabrics such as cotton and silk.

Also Check: How Do You Determine If You Have Shingles

Can There Be Any Complications Or Risks

As with any procedure, side-effects may occur. However, these are usually minor and there is little risk of serious harm.

Side-effects may include

• Mild local tenderness and/or bruising at the site of the injection, that usually settles over the first few days.
• Pneumothorax. There is a small chance of puncturing the lung . This can lead to pain and breathlessness. The pain is often a severe pain, which is sharp and worse on taking a large breath in. If this symptom were to occur or you were to feel breathless then you must seek immediate medical help since this may require treatment and a stay in hospital.
• During the injection, you may experience signs of local anaesthetic toxicity if the injection is passing into a blood vessel. You should inform your doctor immediately if you develop tingling around your mouth or a metallic taste, ringing in your ears, feeling drunk, dizzy, blurred vision, muscle twitches or difficulty in breathing
• The local anaesthetic may rarely spread causing some numbness. Should this occur, the effect is temporary and will rapidly resolve over minutes or rarely hours
• Infection. This is rare. You should seek medical help if there is local warmth or redness over the site of injection with tenderness and/or you feel hot and unwell. This may require antibiotic treatment
• Nerve injury is extremely rare
• Injection treatments are not always effective and may not help your pain

Quality Of The Included Studies

The heterogeneity between the trials included in this review is high in terms of PHN incidence. However, when the outcomes of the subgroups were assessed according to the type of nerve block , heterogeneity was insignificant . Despite the poor quality of some trials, the paucity of high quality randomized controlled trials made us include those trials in the meta-analyses because there were no significant differences in the outcomes that are relevant to this review.

Risk of bias summary: review authors’ judgements about each risk of bias item for each included study. Green = low risk of bias yellow = unclear risk of bias, red = high risk of bias.

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Preparing For A Nerve Block

There are no special preparations needed for a nerve block. You can eat and drink normally beforehand. Dont take any anti-inflammatory medicines, such as ibuprofen or naproxen, within 24 hours of your nerve block procedure. If you take blood thinners such as aspirin , heparin, or warfarin , inform your doctor before scheduling a nerve block.

If youre having a nerve block for a surgery, your doctor might have some specific instructions for you to follow prior to your surgery, especially if several types of anesthetic are going to be used. This might include not eating or drinking anything for 6 to 12 hours prior to your surgery. Be sure to confirm these instructions with your doctor ahead of your surgery day.

Make sure you have someone available to take you home after the procedure. People whove had a nerve block shouldnt drive themselves home.

In general, the procedure for a nerve block involves these steps:

The entire procedure will likely take less than 30 minutes.

Types Of Nerve Blocks

Nerve blocks can be temporary or longer-lasting. Healthcare providers may give them with local anesthesia after numbing where the needle enters the skin. They can also block pain signals to an area by deliberately cutting or destroying certain nerves during surgery.

These are types of surgical nerve blocks:

• Sympathetic blockade. The healthcare provider gives a drug to block pain from the sympathetic nervous system in one particular area.

• Neurectomy. A damaged peripheral nerve is surgically destroyed.

• Rhizotomy. The surgeon destroys the root of the nerves that extend from the spine.

These are types of nonsurgical nerve blocks:

• Epidural analgesia or anesthesia. The healthcare provider may inject medicine outside the spinal cord.

• Spinal anesthesia or analgesia. The healthcare provider may inject medicine in the fluid surrounding the spinal cord.

• Peripheral nerve blockade. The healthcare provider may inject medicine around a target nerve causing pain.

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How Quickly Does It Relieve Pain

Trigeminal Nerve Blocks can quickly relieve pain for those suffering from Shingles. The blocks work by numbing the trigeminal nerve, which is the nerve that sends pain signals to the brain. This can provide relief within a few minutes and can last for several days or weeks. It is a safe and effective way to manage pain associated with Shingles.

Are Multiple Treatments Needed?

The answer to this question depends on the individual case. Some people only need one treatment, while others may require multiple treatments. The number of treatments needed also depends on the severity of the shingles. In general, the earlier the treatment is started, the fewer treatments will be required.