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King and Robert, Concerning the management of pain associated with herpes zoster and of postherpetic neuralgia, Pain, 33 (1988) 73–78
36X
Pam. 35 (19XX) 36%-36’) Elsevicr
PAI 01325
King and Robert, Concerning the management of pain associated with herpes zoster and of postherpetic neuralgia, Pain, 33 (1988) 73-78 Marilyn
R. Kassirer
Boston Uniuersity School of Medicine, Director Pain Management Team, Veterans Administratron Boston, MA 02108 (U.S.A.)
Outpatient
Boston, Dear Editor. Twenty years ago it was suggested that chloroform applied to herpes simplex lesions of the mouth area would either dry the lesions more quickly or diminish the discomfort of the lesion. It was my personal experience that this method failed to be effective in either regard. The article by Dr. King in Pain brought to mind several of our patients who had not responded to multitudinous medications for post-herpetic neuralgia. In view of the fact that chloroform was not readily available, we attempted to apply aspirin topically. We mixed 1 crushed 375 mg aspirin* tablet in 2 tablespoons of Vaseline Intensive Care Lotion (Chesebrough Ponds Inc., Greenwich, CT) and applied it to the areas of post-herpetic scarring and pain in 4 patients. One patient, a 68-year-old woman with 17 months of post-herpetic pain, could not be compliant with any routine therapy because of her mental anguish, but in the office trials, her pain improved within 15 min. Two other patients with post-herpetic neuralgia of 6-12 months duration utilized the mixture locally and within 15 min had improvement of their pain. The first of these patients is a man of 68 years with severe insomnia
* Bayer aspirin York, NY).
(Glenbrook
0304-3959/88/$03.50
Lab Div., Sterling
Drug Inc., New
0 1988 Elsevier Science Publishers
Clinic, I7 Court St.,
MA, 26 July 1988
because of his post-herpetic pain. His pain improved to the degree that he was able to resume normal sleep after use of the topical application 3-4 times/day for 2 weeks. The second is a woman of 62 who only required the application of the mixture intermittently when the pain became acute. She found relief within 15 min of application. The fourth patient is a 70-year-old man who had been on carbamazepine for the post-herpetic neuralgia with relief of his pain, but was left with severe, constant dysesthesia on the fingers and medial forearm of the left side. Twenty minutes after topical application of the mixture to the dysesthetic area, the discomfort resolved and the improvement lasted for 3 h at a time. He continues to have the same improvement after 1 month. It is amazing that such old folk remedies may in fact have continued usefulness. It is tempting to speculate on the underlying mechanisms of action of the acetylsalicylate [1,2]. It may be that in scarred tissue as in post-herpetic neuralgia, diminished blood flow to the local area precludes systemic distribution of medication taken orally. But local absorption allows the action of the medication to take its fully concentrated effect on nociceptive peripheral receptors. There is obviously reason to further study this apparently harmless but helpful treatment. The hope is that these suffering patients may be spared toxic, addictive, or surgical interventions.
B.V. (Biomedical
Division)
References 1 Levitan, H. and Barker, tion selectivity reversibly (1972) 63-65.
2 Neto, F.R., Further studies on the action of salicylates on nerve membranes, Eur. J. Pharmacol., 68 (1980) 155-162. J.L., Membrane permeability: altered by salicylate, Science,
ca178
Pam. 35 (19XX) 36%-36’) Elsevicr
PAI 01325
King and Robert, Concerning the management of pain associated with herpes zoster and of postherpetic neuralgia, Pain, 33 (1988) 73-78 Marilyn
R. Kassirer
Boston Uniuersity School of Medicine, Director Pain Management Team, Veterans Administratron Boston, MA 02108 (U.S.A.)
Outpatient
Boston, Dear Editor. Twenty years ago it was suggested that chloroform applied to herpes simplex lesions of the mouth area would either dry the lesions more quickly or diminish the discomfort of the lesion. It was my personal experience that this method failed to be effective in either regard. The article by Dr. King in Pain brought to mind several of our patients who had not responded to multitudinous medications for post-herpetic neuralgia. In view of the fact that chloroform was not readily available, we attempted to apply aspirin topically. We mixed 1 crushed 375 mg aspirin* tablet in 2 tablespoons of Vaseline Intensive Care Lotion (Chesebrough Ponds Inc., Greenwich, CT) and applied it to the areas of post-herpetic scarring and pain in 4 patients. One patient, a 68-year-old woman with 17 months of post-herpetic pain, could not be compliant with any routine therapy because of her mental anguish, but in the office trials, her pain improved within 15 min. Two other patients with post-herpetic neuralgia of 6-12 months duration utilized the mixture locally and within 15 min had improvement of their pain. The first of these patients is a man of 68 years with severe insomnia
* Bayer aspirin York, NY).
(Glenbrook
0304-3959/88/$03.50
Lab Div., Sterling
Drug Inc., New
0 1988 Elsevier Science Publishers
Clinic, I7 Court St.,
MA, 26 July 1988
because of his post-herpetic pain. His pain improved to the degree that he was able to resume normal sleep after use of the topical application 3-4 times/day for 2 weeks. The second is a woman of 62 who only required the application of the mixture intermittently when the pain became acute. She found relief within 15 min of application. The fourth patient is a 70-year-old man who had been on carbamazepine for the post-herpetic neuralgia with relief of his pain, but was left with severe, constant dysesthesia on the fingers and medial forearm of the left side. Twenty minutes after topical application of the mixture to the dysesthetic area, the discomfort resolved and the improvement lasted for 3 h at a time. He continues to have the same improvement after 1 month. It is amazing that such old folk remedies may in fact have continued usefulness. It is tempting to speculate on the underlying mechanisms of action of the acetylsalicylate [1,2]. It may be that in scarred tissue as in post-herpetic neuralgia, diminished blood flow to the local area precludes systemic distribution of medication taken orally. But local absorption allows the action of the medication to take its fully concentrated effect on nociceptive peripheral receptors. There is obviously reason to further study this apparently harmless but helpful treatment. The hope is that these suffering patients may be spared toxic, addictive, or surgical interventions.
B.V. (Biomedical
Division)
References 1 Levitan, H. and Barker, tion selectivity reversibly (1972) 63-65.
2 Neto, F.R., Further studies on the action of salicylates on nerve membranes, Eur. J. Pharmacol., 68 (1980) 155-162. J.L., Membrane permeability: altered by salicylate, Science,
ca178