Post-Herpetic Neuralgia (Investigational Adjunct)

Patienten-Zusammenfassung

Ist dies FDA-zugelassen fuer diese Anwendung?

Not FDA-cleared for post-herpetic neuralgia. FDA cleared medicinal leeches only for venous congestion in microsurgical reconstruction (K040187, 2004). Use here is investigational.

Welche Evidenz existiert?

Tier C (investigational). There are no published controlled trials. Evidence-based first-line therapies with strong RCT support are: gabapentin or pregabalin, tricyclic antidepressants (nortriptyline, amitriptyline), duloxetine, topical lidocaine 5 percent patch, topical capsaicin 8 percent patch, and (for refractory cases) opioids or interventional pain procedures. Prevention with the recombinant shingles vaccine (Shingrix) is highly effective. Most post-herpetic neuralgia improves over months to a year, but a minority have persistent pain that profoundly affects quality of life.

Hauptrisiken

• Bleeding from the bite site for 6 to 24 hours after detachment
• Bruising over previously herpes-affected skin for 5 to 10 days
• REACTIVATION RISK: trauma to dermatome may trigger zoster recurrence or transient symptom flare
• Local skin or, rarely, Aeromonas hydrophila infection
• Allergic reaction to leech saliva (uncommon)
• Worsening of allodynia and burning pain from local irritation
• Delay of evidence-based pharmacotherapy and interventional pain procedures
• Risk in elderly or frail patients with anemia or fall risk

Wer dies nicht in Betracht ziehen sollte

• Patients with active herpes zoster lesions (vesicles, crusting) - this is a contagious viral infection
• Patients with disseminated zoster or zoster ophthalmicus involving V1 distribution
• Patients on anticoagulants, with hemophilia, or with severe anemia
• Immunocompromised patients (chemotherapy, HIV, transplant, high-dose corticosteroids)
• Patients who have not tried evidence-based pharmacotherapy (gabapentinoids, TCAs, topical agents)
• Patients with active dermatitis or broken skin over the affected dermatome

Was Sie Ihren Kliniker fragen sollten

• Have I tried gabapentin or pregabalin at adequate doses and duration?
• Have I tried tricyclic antidepressants (nortriptyline) or duloxetine?
• Have I tried topical 5 percent lidocaine or 8 percent capsaicin patch?
• Am I a candidate for interventional pain procedures (nerve block, intercostal block, sympathetic block, spinal cord stimulator)?
• Have I received the recombinant shingles vaccine (Shingrix) to prevent recurrence?
• Where exactly will the leech be placed - confirm NEVER over active or recently healed zoster lesions?
• What is the practitioner's plan if symptoms worsen or if zoster reactivates?

Wann dringende medizinische Versorgung suchen

• New crops of vesicles or spreading rash (possible zoster reactivation or dissemination)
• Eye pain, visual change, or rash on the forehead or nose (possible zoster ophthalmicus - sight-threatening)
• Fever, chills, or systemic symptoms with the rash (possible disseminated zoster)
• Severe worsening of pain, numbness, or new weakness in the affected dermatome
• Bleeding from a bite site lasting more than 24 hours
• Spreading redness, pus, or warmth at the bite site
• Hives, facial or throat swelling, or breathing difficulty