PHN refractory to conventional treatment

I saw a new patient in the office yesterday. 70 y/0 M with 1.5 years of severe pain secondary to a shingles outbreak in the left T5/T6 dermatomes. It doesn't appear that he received timely antiviral therapy at the time of outbreak and now he is suffering for it. He even asked to take off his shirt during the middle of the consultation secondary to pain. Prior to seeing me he has tried Hydrocodone, Gabapentin, Lyrica, Amitriptyline, Lidocaine ointment / patches, Calamine lotion and... PHN refractory to conventional treatment
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Source Type: forums