Ultrasound-guided cervical nerve root block (CRB) may be effective in reducing acute cervical herpes zoster (HZ)-related burden of illness and risk for postherpetic neuralgia (PHN), according to a study published in Pain Practice.

Patients with a diagnosis of cervical HZ, zoster-associated pain (ie, a score >3 for the “worst pain in the last 24 hours” question on the Zoster Brief Pain Inventory assessment), and who were ≥50 years of age, were recruited. The investigators randomly assigned patients to receive ultrasound-guided CRB with a mixed drug liquid (n=70; treatment) or with similar-looking placebo (n=70; control). All participants were given a 7-day oral antiviral treatment and treatment with pregabalin and analgesics as needed. The treatment’s primary efficacy was evaluated using burden of illness scores at 30 days. Secondary efficacy was evaluated with burden of illness scores from 30 to 90 days and from 90 days to 180 days, as well as with quality of life, concomitant analgesic use, and PHN incidence.

Participants who received treatment vs placebo indicated lower burden of illness at 30 days (92.55 vs 112.72, respectively; P <.01), as well as from 30 to 90 days, and from 90 to 180 days (P <.01 for both).

Patients who received treatment had a lower incidence of PHN at 90 days compared with 180 days (4 vs 13, respectively; P =.036) and reported a greater improvement in quality of life compared with patients who received placebo (P <.05). Analgesic use was reduced to a greater extent in participants who received treatment vs placebo (P <.05). No serious adverse events were reported.

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A limitation of the study is the use of rescue analgesics, which represents a confounder that was not controlled for.

“We concluded that ultrasound-guided CRB combined with steroid as an early intervention during acute phase of HZ could effectively reduce the burden of illness due to acute HZ associated pain in the cervical dermatome region, and might be a feasible preventive strategy to reduce the incidence of PHN,” the researchers noted.

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Reference

Zheng S, Li X, Yang X, He L, Xue Y, Yang Z et al. Ultrasound-guided cervical nerve root block for the treatment of acute cervical herpes zoster: a randomized-controlled clinical study [published online February 7, 2019]. Pain Pract. doi: 10.1111/papr.12770