Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Case report : Postherpetic Neuralgia

포진후 신경통의 치료 증례

  • Bae, Kook-Jin (Department of Oral medicine, School of Dentistry, Chosun University) ;
  • Ahn, Jong-Mo (Department of Oral medicine, School of Dentistry, Chosun University) ;
  • Yoon, Chang-Lyuk (Department of Oral medicine, School of Dentistry, Chosun University) ;
  • Cho, Young-Gon (Department of Operative Dentistry, School of Dentistry, Chosun University) ;
  • Ryu, Ji-Won (Department of Oral medicine, School of Dentistry, Chosun University)
  • 배국진 (조선대학교 치의학전문대학원 구강내과학교실) ;
  • 안종모 (조선대학교 치의학전문대학원 구강내과학교실) ;
  • 윤창륙 (조선대학교 치의학전문대학원 구강내과학교실) ;
  • 조영곤 (조선대학교 치의학전문대학원 보존학교실) ;
  • 유지원 (조선대학교 치의학전문대학원 구강내과학교실)
  • Received : 2010.02.04
  • Accepted : 2010.03.10
  • Published : 2010.03.30
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Abstract

Herpes zoster (HZ) is the secondary manifestation of an earlier infection with the varicella-zoster virus in one or more dermatomes. As reactivation of the virus is linked to an age-related diminished virus-specific and cell-mediated immunity, HZ develops mainly in elderly people. Acute zoster is painful, but does not incur lasting morbidity. Reactivation of the varicella-zoster virus in the trigeminal nerve (Herpes zoster) occur with severe pain and rash in the oro-facial region. The acute pain decreases as the rash begins to heal. Postherpetic neuralgia(PHN), the most frequent complication of herpes zoster, is usually defined as pain in the involved dermatome that is still present 3 month after rash onset. The clinical characteristics of PHN are, eposodic stabbing pain, burning pain and allodynia, with hypoesthesia and/or dysesthesia. $Neurometer^{(R)}$(neuroselective sensory nerve conduction threshold: sNCT, Automated current perception threshold: CPT, neurotron incorporated. Baltimore, Maryland. 21209 U.S.A.) is convenient, rapid and noninvasive, and allows objective assessment of sensory disturbance. This case is about the postherptic neuralgia patient assessed with $Neurometer^{(R)}$. From this case, we reviewed the pathophysiology and the treatment of PHN and recommend the assessment of pain intensity with $Neurometer^{(R)}$ as quantitative and objective method.

대상포진(Herpes Zoster:HZ)은 수두 대상포진 바이러스(Varicella Zoster virus)에 의해 야기된 속발성 또는 잠복성 감염이다. 증령에 따라 바이러스 특이적 면역 및 세포 매개 면역력이 감소하면서 바이러스가 재활성화되기 때문에, 대상포진은 주로 노년층에서 호발한다. 대상포진에 이환되면, 극심한 급성 통증이 발생하게 되고 수개월에 걸쳐서 회복하게 된다. 포진후신경통(Postherpetic neuralgia:PNH)은 대상포진의 대표적인 합병증의 하나로, 대상포진에 이환된 후 발생한 통증이 3개월 이상 회복되지 않을 때, 포진후신경통으로 진단할 수 있다. 임상적 증상으로는 주기적으로 찌르는 듯한 통증이 동반되는 타는 듯한 통증, 이질통이 발생할 수 있으며, 감각저하 또는 지각이상을 보일 수 있다. $Neurometer^{(R)}$(neuroselective sensory nerve conduction threshold: sNCT, Automated current perception threshold: CPT, neurotron incorporated. Baltimore, Maryland. 21209 U.S.A.)는 신경의 감각이상을 평가하는 데 유용하게 쓰이는 평가기구이다. 이번 증례는 포진후신경통을 주소로 내원한 환자의 치료 증례를 통해, 포진후신경통의 발생기전을 고찰해보고, 그 치료법에 대하여 알아보고, 또한 치료과정 중의 경과관찰 방법으로서 $Neurometer^{(R)}$를 이용하여, 감각이상의 평가 및 경과관찰시 지각이상에 대한 정량적인 평가를 시도하였다.

Keywords

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