63 year-old man with 6 months of right mid back and right flank pain after a bout of shingles infection after he was under stress. This left him a severe and non-relenting burning pain in his right flank and chest wall area. He failed Gabapentin and Hydrocodone-APAP.
Diagnosis: Post herpetic neuralgia.
70 year young man one year history of searing and stabbing left mid-back pain to left flank and rib cage area. The pain is severe and extremely disagreeable.
He did not remember any rash or skin conditions before the onset of his pain. He failed narcotics pain medications.
He has clear scars over the same area of his back and flank pain.
Diagnosis: post herpetic neuralgia.
Treatment: thoracic epidural steroid injection gave him pain relief.
77 year young lady developed a skin rash over her right neck, shoulder and arm and hand and fingers. The rash resolved over few months but a severe burning pain developed in the same area of her rash. The pain was refractory to medication.
Diagnosis: post herpetic neuralgia
MRI - neck: Minimal cervical degenerative disc disease, no stenosis.
Treatment: she failed medication including several neuromodulators. She had cervical (neck) epidural steroid injection with immediate and substantial pain relief.
67 year young man with 1 year history of left middle to lower back pain from a herpes outbreak one year ago.
He failed many pain medication.
He has burning pain with tenderness to touch over left lower back. Left lower back scar from his shingles.
Diagnosis: post herpes neuralgia; lumbar radiculopathy
Treatment: Lumbar transforaminal epidural injection- left L2-4
Outcome: immediate pain relief.
67 year young man gradually onset focal left middle to lower back pain expanded to his left flank area for one year. The pain is burning in nature and does not change much. Nothing makes it better or worse. He did not notice any rash before the pain started. The painful area resembles a belt.
He had local pain even with touch over his left flank. He failed oxycontin and Gabapentin.
Diagnosis: Post herpes neuralgia
Management: thoracic transforaminal epidural steroid injection.