Postherpetic Neuralgia With Sciatic Nerve Paresis Treated With Peripheral Nerve Stimulator Implantation Device

Herpes zoster, commonly known as shingles, is caused by reactivation of the latent varicella zoster virus in the sensory ganglia. It typically presents as painful grouped vesicles confined to one or two dermatomes. Most lesions resolve within two to four weeks; however, a subset of patients go on to develop postherpetic neuralgia in the area of the original zoster rash, characterized by allodynia and hyperalgesia lasting months or even years. The risk increases with age, immunosuppression, and underlying conditions such as cancer, kidney or liver disease, chronic lung disorders, etc. Although the use of oral antiviral medications during the early stages may reduce the severity and duration of acute herpes zoster, their effect on preventing postherpetic neuralgia remains limited. In this article, we report the case of a 75-year-old female with severe postherpetic neuralgia involving the left sciatic nerve distribution, with resulting motor paresis. After an extensive trial of various oral medication regimens and a lumbar epidural injection, which provided short-term relief, the patient underwent peripheral nerve stimulator (PNS) implantation, with eventual favorable response. Our case report highlights the potential role of using PNS to treat severe postherpetic neuralgia refractory to mainstay conservative treatment modalities.