Multimodal interventional pain management for refractory postherpetic neuralgia: a clinical case report.

Abstract

Background: Postherpetic neuralgia (PHN) is a challenging neuropathic pain condition that can persist despite pharmacologic therapy, resulting in significant disability. Interventional pain techniques such as pulsed radiofrequency (PRF) and sympathetic blocks have demonstrated efficacy in refractory cases.

Case Report: A woman in her 50s presented with persistent neuropathic pain in the ulnar nerve distribution of her left-hand following herpes zoster infection. Despite antiviral and multimodal pharmacologic therapy, her pain remained severe and disabling. She underwent a multimodal interventional approach including prolotherapy, ultrasound-guided pulsed radiofrequency ablation of the ulnar nerve, stellate ganglion block, and structured rehabilitation therapy. Following these procedures, the patient’s pain intensity decreased from 7–8 to 2–4 on the visual analogue scale, with significant improvement in grip strength and daily function.

Conclusion: This case highlights the role of multimodal image-guided interventions in the management of refractory PHN. Early adoption of interventional techniques combined with rehabilitation may achieve durable pain relief and functional recovery when pharmacologic therapy fails.

Keywords: Postherpetic neuralgia, pulsed radiofrequency, stellate ganglion block, prolotherapy, neuropathic pain, multimodal therapy

Citation: Hardi IM, Pryambodho P, Rahendra R. Multimodal interventional pain management for refractory postherpetic neuralgia: a clinical case report. Anaesth. pain intensive care 2025;30(2):282-284. DOI: 10.35975/apic.v30i2.3140

Received: November 11,2025; Revised: November 17,2025; Accepted: November 17,2025