Experience of Management of Intractable Postherpetic Neuralgia on Perineum: A Case Report

Herpes zoster is a transient disease caused by the reactivation of latent varicella zoster virus. Approximately one in every three people develops herpes zoster during their life time. Postherpetic neuralgia is the most common complication associated with herpes zoster, and it often persists for several years and even for a lifetime despite the pharmacological treatment. A 74-year-old woman experienced severe postherpetic neuralgia on the coccyx and the vulva for 18 months. Authors performed six times of fluoroscopy-guided nerve blocks including pudendal nerve block, ganglion impar block, and L1 transforaminal epidural block. With repeated nerve blocks, her numeric rating scale decreased from 8 to 4, and after 5 months, her pain was controlled only with oral medication. Postherpetic neuralgia might be treated with nerve blocks regardless of its duration.