Efficacy of Modified Jaipur Block in Post Herpetic Neuralgia

Modified Jaipur Block in Post Herpetic Neuralgia

Authors

  • Nadia Akhtar PGR Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
  • Muhammad Khurram Shahzad Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
  • Tahir Hassan Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
  • Nazia Hanif Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
  • Asma Naz Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
  • Sara Anwar Dermatology Department, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i02.1252

Keywords:

Dexamethasone, Modified Jaipur Block, Post Herpetic Neuralgia, Visual Analogue Scale

Abstract

Post herpetic neuralgia (PHN), a chronic neuropathic pain arising after herpes zoster (shingles) infection is notable, if discomfort persists beyond 90 days from the initial outbreak. Objective: To determine the efficacy of  Modified Jaipur Block in reducing pain in patients with Post Herpetic Neuralgia. Methods: An uncontrolled clinical trial at Sheikh Zayed Hospital, Rahim Yar Khan, from January 2023 to September 2023 included 103 post herpetic neuralgia patients aged 20-80 years. Pain severity assessed using VAS score at baseline and follow-ups; efficacy defined as >75% decrease in VAS pain score at 6 months. Statistical analysis utilized SPSS 26.0, employing paired t-tests and Chi-square tests for efficacy and subgroup analyses. Results: In 103 patients predominantly aged 51-65 years and suffering mainly from thoracic pain, the Modified Jaipur block treatment yielded substantial reductions in Visual Analogue Scale (VAS) scores. From an initial mean VAS of 8.15±1.389, scores declined significantly to 2.66±2.379 at the last follow-up (p<0.001). A notable 73.8% of patients achieved remission, while relapses were observed in 7.8%. No association between remission rates and demographic or clinical variables was detected (p>0.05). At the 6-month follow-up, 61.2% of patients demonstrated efficacy (over 75% reduction in VAS pain scores), with a significantly higher efficacy noted in cases of intermittent pain (p<0.05). Conclusions: The Modified Jaipur block treatment demonstrated significant efficacy in pain reduction. The study underscores the potential of this treatment modality for targeted pain management. 

References

Mallick-Searle T, Snodgrass B, Brant JM. Post herpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. Journal of Multidisciplinary Healthcare. 2016 Sep: 447-54. doi: 10.2147/JMDH.S106340. DOI: https://doi.org/10.2147/JMDH.S106340

Curran D, Schmidt-Ott R, Schutter U, Simon J, Anastassopoulou A, Matthews S. Impact of herpes zoster and post herpetic neuralgia on the quality of life of Germans aged 50 or above. BMC Infectious Diseases. 2018 Dec; 18(1): 1-1. doi: 10.1186/s12879-018-3395-z. DOI: https://doi.org/10.1186/s12879-018-3395-z

van Oorschot D, Vroling H, Bunge E, Diaz-Decaro J, Curran D, Yawn B. A systematic literature review of herpes zoster incidence worldwide. Human Vaccines & Immunotherapeutic. 2021 Jun; 17(6): 1714-32. Doi: 10.1080/21645515.2020.1847582. DOI: https://doi.org/10.1080/21645515.2020.1847582

Malik A, Jang FF, Moosa M, Iqbal A, Hassan SAA, Malik A: Frequency of Post herpetic Neuralgia in Herpes Zoster Patients. Pakistan Journal of Medical and Health Sciences. 2021 Jun; 15(6): 1305–8. 10.53350/pjmhs211561305. DOI: https://doi.org/10.53350/pjmhs211561305

Forbes HJ, Bhaskaran K, Thomas SL, Smeeth L, Clayton T, Mansfield K et al. Quantification of risk factors for post herpetic neuralgia in herpes zoster patients: a cohort study. Neurology. 2016 Jul; 87(1): 94-102. doi: 10.1212/WNL.0000000000002808. DOI: https://doi.org/10.1212/WNL.0000000000002808

Bates D, Schultheis BC, Hanes MC, Jolly SM, Chakravarthy KV, Deer TR et al. A comprehensive algorithm for management of neuropathic pain. Pain Medicine. 2019 Jun; 20(1): S2-12. doi: 10.1093/pm/pnz075. DOI: https://doi.org/10.1093/pm/pnz075

Maloney J, Pew S, Wie C, Gupta R, Freeman J, Strand N. Comprehensive review of topical analgesics for chronic pain. Current Pain and Headache Reports. 2021 Feb; 25: 1-8. doi: 10.1007/s11916-020-00923-2. DOI: https://doi.org/10.1007/s11916-020-00923-2

Kim HJ, Ahn HS, Lee JY, Choi SS, Cheong YS, Kwon K et al. Effects of applying nerve blocks to prevent post herpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis. The Korean Journal of Pain. 2017 Jan; 30(1): 3-17. doi: 10.3344/kjp.2017.30.1.3. DOI: https://doi.org/10.3344/kjp.2017.30.1.3

Kim J, Kim MK, Choi GJ, Shin HY, Kim BG, Kang H. Pharmacological and non-pharmacological strategies for preventing post herpetic neuralgia: a systematic review and network meta-analysis. The Korean Journal of Pain. 2021 Oct; 34(4): 509-33. doi: 10.3344/kjp.2021.34.4.509. DOI: https://doi.org/10.3344/kjp.2021.34.4.509

Xing XF, Zhen-Feng Z, Feng-Jiang Z, Yan M. The effect of early use of supplemental therapy on preventing post herpetic neuralgia: a systematic review and meta-analysis. Pain physician. 2017; 20(6): 471. doi: 10.36076/ppj.2017.20.5.471. DOI: https://doi.org/10.36076/ppj.2017.20.5.471

Shrestha M and Chen A. Modalities in managing post herpetic neuralgia. The Korean Journal of Pain. 2018 Oct; 31(4): 235-43. doi: 10.3344/KJP.2018.31.4.235. DOI: https://doi.org/10.3344/kjp.2018.31.4.235

Aggarwal A, Suresh V, Gupta B, Sonthalia S. Post-herpetic neuralgia: a systematic review of current interventional pain management strategies. Journal of Cutaneous and Aesthetic Surgery. 2020 Oct; 13(4): 265. doi: 10.4103/JCAS.JCAS_45_20. DOI: https://doi.org/10.4103/JCAS.JCAS_45_20

Zhang X, Wang Z, Xian Y. Efficacy of local anaesthetic and steroid combination in prevention of post-herpetic neuralgia: A meta-analysis. Pakistan Journal of Medical Sciences. 2022 Mar; 38(3Part-I): 757. doi: 10.12669/pjms.38.3.5140. DOI: https://doi.org/10.12669/pjms.38.3.5140

Puri N. Modified Jaipur block for the treatment of post‐herpetic neuralgia. International Journal of Dermatology. 2011 Nov; 50(11): 1417-20. doi: 10.1111/j.1365-4632.2011.5083.x. DOI: https://doi.org/10.1111/j.1365-4632.2011.5083.x

Begum MR and Hossain MA. Validity and reliability of visual analogue scale (VAS) for pain measurement. Journal of Medical Case Reports and Reviews. 2019 Nov; 2(11): 394-402.

Bhargava R, Bhargava S, Haldia KN, Bhargava P. Jaipur block in post herpetic neuralgia. International Journal of Dermatology. 1998 Jun; 37(6): 465-8. doi: 10.1046/j.1365-4362.1998.00392.x. DOI: https://doi.org/10.1046/j.1365-4362.1998.00392.x

Sharma RK, Gupta M, Tegta GR, Verma G, Rani R. Post herpetic neuralgia: A retrospective study to evaluate response to modified Jaipur block with increased concentration of dexamethasone. Indian Journal of Dermatology. 2021 Sep; 66(5): 459. doi: 10.4103/ijd.IJD_390_20. DOI: https://doi.org/10.4103/ijd.IJD_390_20

Ni J, Wang X, Tang Y, Yang L, Zeng Y, Guo Y. Subcutaneous injection of triamcinolone and lidocaine to prevent post herpetic neuralgia. Pain Physician. 2017; 20(5): 397.

Khalid M and Mujtaba G. Treatment of post-herpetic neuralgia with subcutaneous injections of mixture of xylocaine, bupivacaine and dexamethasone. JPAD-Journal of Pakistan Association of Dermatologists. 1999; 9(3): 12-5.

Amjad M and Mashhood AA. Acetonide with lignocaine compared with lignocaine alone in the treatment of post herpetic neuralgia. JCPSP. 2005; 15(11): 683-5.

Asim SA, Agha HM, Masroor M. Post-heretic neuralgia: intra-lesional triamcinolone in the treatment. The Professional Medical Journal. 2016 Jan 10; 23(01): 056-9. doi: 10.29309/TPMJ/2016.23.01.795. DOI: https://doi.org/10.29309/TPMJ/2016.23.01.795

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Published

2024-02-29
CITATION
DOI: 10.54393/pjhs.v5i02.1252
Published: 2024-02-29

How to Cite

Akhtar, N., Shahzad, M. K., Hassan, T., Hanif, N., Naz, A., & Anwar, S. (2024). Efficacy of Modified Jaipur Block in Post Herpetic Neuralgia : Modified Jaipur Block in Post Herpetic Neuralgia. Pakistan Journal of Health Sciences, 5(02), 79–83. https://doi.org/10.54393/pjhs.v5i02.1252

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