May 6, 2009 -- A surgically implanted pump that delivers medication to the spinal fluid
helps reduce the persistent pain that can linger in some patients after they recover
from shingles, according to a new study.
"All patients showed a greater than 50% improvement in pain control," says
Andrew J. Fabiano, MD, a senior resident at the University of Buffalo who was
scheduled to present the findings yesterday at the American Association of
Neurological Surgeons meeting in San Diego. "The patients describe a dramatic
improvement in pain,'' he says. The study follow-up averaged nearly six
Shingles affects about a million people a year in the U.S., according to the
Association for Healthcare
Research and Quality, with risk being much higher for people 65 and
Shingles occurs when the varicella zoster virus that causes chickenpox
reactivates and causes a painful rash on the trunk or other body parts. In about 15% of
patients, Fabiano says, the pain persists a month or longer, a condition called
postherpetic neuralgia or post-shingles pain. (A shingles vaccine, Zostavax, is now recommended for certain people by the
Fabiano and his colleagues evaluated five patients -- one woman and four men
-- all of whom had post-shingles pain. Their average age was 75 and none had
been helped enough by the typically prescribed oral pain medications given for
They decided to study the pump system, already on the market and used for
other chronic pain conditions, after finding little published on it for
They implanted a pump, "about the size of a hockey puck," Fabiano says, in a
procedure that takes about 45 minutes. The pump is placed under the skin, typically in the abdomen, and is attached to a
small tube inserted into the spine. The medication goes from the pump through
the tube and enters the spinal fluid.
Before the pump was implanted, all patients were given a trial, Fabiano
says, either by injecting the pain medicine into the spinal area or placing a
temporary catheter to deliver the medication for 24 or 48 hours to be sure the
medicine worked for their pain.
The amount of medication delivered
is preprogrammed and can't be changed by the patient, he says. The drugs
delivered varied and included morphine with or without other drugs.
Fabiano acknowledges that the study is small and that they did not compare
the patients with others not on the pump to determine the differences in pain
relief. No outside sources funded the study.
The pump isn't for everyone, he says. "This is not a first-line treatment,"
he tells WebMD. "The first line is oral or transdermal [skin patch] medication."
"It's for a minority of patient with shingles," he says. But for those whose
pain doesn't respond to other treatments, he says, the pump is worth
The patients didn't report any side effects.
Post-Shingles Pain: Pump Is Last Resort
Another expert agrees that the pump is a last resort for shingles patients
in pain. "The ideal candidate is someone who has not been helped enough by
other treatments who gets substantial pain relief from taking these opioid
medicines by mouth but can't continue to do so because of severe side effects,"
says Anne Louise Oaklander, MD, PhD, an associate professor of neurology at
Harvard Medical School who reviewed the study results.
Those side effects include drowsiness and nausea, she says.
"If oral [medicines] work fine," she says, "stick with it."