Targeted Nerve Block Plus IV Infusion Relieves Refractory Postherpetic Neuralgia: Case Report
A recent case report highlights that pairing a targeted nerve procedure with an IV medication drip can provide lasting relief for severe shingles pain that fails to respond to standard medications. This innovative two-step approach successfully conquers the stubborn, debilitating nerve pain known as postherpetic neuralgia
The findings of the case report are published in the Indian Journal of Pain in June 2026 by Dr. Dhanya Ravindran and colleagues from Bhopal Spine and Pain Relief Center in Madhya Pradesh, India.
The documented case holds immense practical importance for clinical practice because the currently available medical literature rarely explores the seamless integration of advanced physical interventional strategies with targeted pharmacological central desensitization. By actively addressing complex clinical scenarios where standard medical therapies entirely fail to provide relief, this distinctive multimodal approach offers pain practitioners a highly robust and effective alternative to mitigate the significant debilitation associated with intractable nerve pain.
A 73-year-old woman suffering from severe, lancinating axillary pain five months after a shingles outbreak initially underwent preoperative blood profiling and continuous monitoring before receiving targeted thoracic DRG PRFA. Following a brief period of partial relief and a rapid pain relapse within one month, physicians diagnosed her with refractory PHN and administered a comprehensive three-day intravenous ketamine and lignocaine infusion, ultimately leaving the patient entirely independent and nearly pain-free at her final six-month clinical follow-up.
The paroxysmal pain characteristic of PHN originates from abnormal high-frequency nerve discharges, prompting practitioners to utilize PRFA to successfully modulate biological pain pathways and inhibit glial cell activation without causing structural tissue damage. Concurrently, intravenous ketamine effectively blocks N-methyl-D-aspartate (NMDA) receptors, while lignocaine actively inhibits sodium channels, successfully reversing the detrimental central sensitization and neuronal hyperexcitability that continuously drive this persistent neuropathic condition.
This sequential, multimodal treatment strategy holds paramount clinical relevance for modern pain practitioners who actively manage frail or elderly patients struggling continuously with the adverse physiological effects of prolonged and ineffective conventional medical therapies. By intelligently combining localized, targeted interventional techniques with broad systemic desensitizing pharmacological agents, this critical study actively broadens our current medical understanding of complex pain management and establishes a highly promising precedent for designing future clinical research trials addressing refractory neuropathic conditions.
Reference
Ravindran D, Singh J. Central desensitisation sequential to pulsed radiofrequency ablation of thoracic dorsal root ganglion in refractory postherpetic neuralgia: A case report. Indian J Pain 2026;40:115‑7.
