Over time, normal sensations like light touch or temperature may be confused with sharp, excruciating pain by the brain. These signals can cause intermittent electrical shock-like sensations in the region. ![]() The damage causes the nerve(s) in a specific dermatome (an area of skin that is mainly supplied by a single spinal nerve) to send abnormal signals to the brain. PHN is thought to be the result of nerve damage caused by the spread of the herpes zoster virus during the reactivation phase. It will occur in approximately 20% of patients over the age of 50. Postherpetic neuralgia refers to the pain syndrome following an episode of shingles, after the rash has resolved. Recurrent herpes zoster, on the other hand, is rare, occurring in less than 5% of the population. population at some point in their lifetime, and up to 50% of people that live to the age of 85., The incidence of herpes zoster is markedly increased with age and people with impaired immune systems, e.g., those with HIV/AIDS, certain cancers, or those on immunosuppressive medications. It will affect about 20% to 30% of the U.S. Shingles has the highest incidence of all neurological illnesses, occurring in about 1 million people in the U.S. In these cases, the rash will involve the eye and face. Less commonly, the zoster virus will find its way to ganglion of the trigeminal nerve in the brain. Sacral dermatomes are the least frequently affected, making up 2% to 8% of cases. Cervical and lumbar dermatomes each make up 10% to 20% of cases. The most commonly affected dermatomes are in the thoracic region (50% of cases) – this is because the virus most commonly chooses to hide within the DRG of the thoracic spine. There are DRG’s up and down both sides of the spine in the cervical, thoracic, lumbar and sacral spine. Each DRG is responsible for collecting sensation of very specific, well-defined regions of the body known as dermatomes. Most commonly, the virus will choose to hibernate in a region of the spine known as the dorsal root ganglion (DRG). In a manner of speaking, since varicella zoster picks its hiding place after the initial bout of chicken pox, the area of a shingles outbreak is predetermined long before the start of the rash. Genicular Neurotomy (aka Genicular Nerve Ablation). ![]()
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