Session Information
Session Title: AA 2022 Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: David L. Salyer, PhD: Averitas Pharma (Products/Services: Yes) (Employment)
Case Diagnosis: An 80-year-old male with postherpetic neuralgia (PHN).
Case Description or Program Description: The patient presented with PHN to the right chest, axilla and shoulder secondary to shingles. He complained of pain and burning (worst in the left scapula), as well as stabbing pains at night causing disrupted/poor sleep. Treatments such as gabapentin, pregabalin, spinal injections, intercostal block, nerve ablation and heat therapy had been tried with limited success.
Medical history: Hypertension; gastroesophageal reflux disease; valacyclovir and prednisone for shingles; and tamsulosin for prostatic hypertrophy. The patient had received the herpes zoster vaccine.
At presentation, pain was rated 3/10 and burning 5/10; and a rash on the right thorax along the T2-4 dermatome, anterior chest, axilla and shoulder. The skin was intact with no lesions, but sensitive to touch. The patient received a single application of Qutenza® (QTZ; capsaicin 8% topical system) on July 12, 2021.
Setting: Outpatient Clinic.
Assessment/Results: During week 1 after receiving QTZ, PHN symptoms were decreased by 10% and Combined Electrochemical Therapy was started (twice weekly for an average of 12 weeks). After 1 month, there was an 80% relief in symptoms, and after 2 months the patient reported decreased stabbing pains. He also achieved an additional 60% decrease in sensitivity to touch and was able to shower with decreased pain. Current symptom scores are: pain, 1/10; burning, 2.5/10.
Discussion (relevance): Clinical guidelines recommend anticonvulsants, tricyclic antidepressants, or topical lidocaine patches as first-line therapies for PHN. However, these agents are not always effective, or they can be associated with intolerable adverse effects. Therefore, the availability of effective and safe alternatives is a step forward in the management of PHN.
Conclusions: This case highlights the benefit of QTZ in an elderly patient with PHN who failed to respond to current first-line therapies.
Level of Evidence: Level V
To cite this abstract in AMA style:
Salyer DL, Martin J. An Elderly Patient with Recalcitrant Postherpetic Neuralgia Treated with Qutenza®: A Case Report [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/an-elderly-patient-with-recalcitrant-postherpetic-neuralgia-treated-with-qutenza-a-case-report/. Accessed May 16, 2025.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-elderly-patient-with-recalcitrant-postherpetic-neuralgia-treated-with-qutenza-a-case-report/