Medical Edge Newspaper Column

Destroying Nerve To Kill Pain Could Just Make Things Worse

Feb. 6, 2006
DEAR MAYO CLINIC:
I have suffered from postherpetic neuralgia for five years. The doctor has located the nerve and wants to "kill" it. What would be the postop effects of this procedure? I am afraid of this operation and what it would leave me with. -- Seattle, Wash.

ANSWER:
Postherpetic neuralgia -- persistent pain that continues after a person has had shingles (herpes zoster) -- can result in extreme discomfort and severely disrupt an individual's life. It's one of the most devastating chronic pain syndromes that exists. Given the severity of the pain involved, it's understandable that people who have this condition may go to great lengths to try to get rid of it. However, you are wise to be wary of a procedure to destroy the nerve that is causing your pain.

From your question, it's unclear if the procedure that's been recommended to you is a temporary measure -- such as a nerve block -- or a permanent one, such as cutting the nerve surgically or destroying it using radiofrequency energy or an injection of medication. No matter which it is, the outlook is the same: Neither is likely to work, and both may result in pain that is actually worse and more difficult to treat than what you have now.

It seems to make sense that by halting the nerve signals that cause the pain -- as is done with a nerve block using local anesthetic or by getting rid of the nerve altogether -- the pain would go away. But often, that's not what happens. In many cases, once the nerve is numb, or even if it's destroyed completely, an individual still feels the pain. It's not clear why this occurs, but the condition is similar to the phantom-limb pain people sometimes experience after amputation. Phantom-limb pain is more complicated to treat and has fewer proven treatments than does postherpetic neuralgia.

If a patient is determined to try one of these treatments, a nerve block would be the preferable route, as it is a temporary measure only. However, at Mayo Clinic, we generally do not recommend nerve blocks for postherpetic neuralgia because they usually are not effective. And because of its overall ineffectiveness and the possibility of causing more severe long-term problems, we would never recommend permanent destruction of a nerve for postherpetic neuralgia.

Other treatment alternatives exist for postherpetic neuralgia. Bandage-like skin patches that contain the pain-relieving medication lidocaine can be placed directly on painful areas and may offer some relief. Certain types of antidepressants may help because they affect the brain chemicals that play a role in how your body interprets pain. Medications used to treat seizures may also lessen the pain associated with postherpetic neuralgia.

I strongly recommend you talk with your physician about these and other treatment options that do not involve destroying the nerve. If you have already tried some of these options without success and your physician doesn't have other suggestions, consider seeking another medical opinion, preferably from a pain medicine specialist who has experience treating postherpetic neuralgia.

-- Paola Sandroni, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minn.