Nerve Operation for Treatment of Shingles

Procedure and Indications

Neurosurgical treatment of shingles is seldom employed and involves cutting (transecting) the nerve branches that conduct the pain sensation. The procedure is indicated only in the most severe forms of postherpetic neuralgia (PHN).

Postherpetic neuralgia

This most common complication of shingles is characterized by pain that lasts for months or years after the rash heals. Most cases of PHN can be managed by the primary care physician and resolve within a year, usually with the help of multiple medications, including topical anesthetics, capsaicin, anticonvulsants, opioids and antidepressants. Severe cases benefit from nerve-blocking injections (e.g., facial herpes zoster), spinal cord electrical stimulation or, as a last resort, from surgery that interrupts the transmission of pain sensation.

Significance

PHN is experienced by 10 to 15 percent of shingles sufferers. It significantly impairs the quality of their daily life. The elderly are most frequently and seriously affected.

Perspectives

Evidence for the efficacy of surgical and procedural interventions in PHN is still scant. Some interventions, such as steroid injection into the thecal space of the spinal cord near the affected nerve, remain controversial.

Warning

These procedures are not without risks. Surgery has the potential to induce pain (including a dreaded complication called anesthesia dolorosa). Your eligibility depends on your particular medical history, present symptoms, age and health status. Talk to your doctor about a non-pharmacologic intervention.