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O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | O C T O B E R 2 0 1 4
Pain management doesn't always involve lumbar spine injec-
tions for workers' comp injuries. Shingles, a disease sparked by
the varicella zoster virus (the same virus responsible for chicken
pox), causes a painful rash and in some cases leaves post-herpetic
neuralgia, a burning or aching sensation on the affected nerves
and skin, for months or years afterwards.
Traditional palliative remedies have included oral narcotic and
non-narcotic medications, antidepressants and transdermal lido-
caine patches. However, since the shingles rash and subsequent
neuralgia often occur along an area of skin served by a particular
neural pathway, pain management practitioners have successfully
provided patients with relief from the painful aftermath through
intercostal nerve blocks. Ultrasound or electrical nerve stimula-
tion can assist providers in determining and reaching the affected
nerve roots.
For patients suffering from shingles, pain management practi-
tioners advocate blocking the nerves early, even before the out-
break has subsided, says Pam Wrobleski, CRNA, MPM, DNAP(c),
CASC, administrator of the Southwestern Ambulatory Surgery
Center in Pittsburgh, Pa. "You don't know who will develop the
neuralgia, and they've found success in administering the nerve
block early on," she says, noting that it might even ease the out-
break's symptoms as well. "Patients will do better if they're
blocked earlier rather than later."
2. Phantom limb pain
Ms. Wrobleski has even seen demonstrations of nerve blocks to
quiet the "phantom limb pain" experienced by patients who have
lost extremities.
"For a long time, phantom limb pain was believed to be a psy-
R E G I O N A L A N E S T H E S I A
