Post-Herpetic the Right Greater and Lesser Occipital Neuralgia in an 80-Year-Old Hispanic-Elderly Woman

Ramirez J1, Alkhudari A1, Patel N1, Kaye A2,3, Fonseca A3, Yazdi C3, Robinson C3.  

1 John H. Stroger, Jr. Cook County Hospital, Anesthesiology and Pain Management, Chicago, IL. 2 Louisiana State University Health Sciences Center, Anesthesiology, Critical Care, and Pain Medicine, Shreveport, LA. 3 Beth Israel Deaconess Medical Center, Harvard Medical School, Anesthesiology, Critical Care, and Pain Medicine, Boston MA.   

Introduction

Relatively common, nearly 33% of people living in the United States will develop herpes zoster at least once, with about 13% of those aged ≥ 60 developing post-herpetic neuralgia (PHN).1,2 The complications of PHN can be quite devasting, leading to fatigue, poor appetite, debilitating pain, and depression, amongst others.3 Furthermore, of this age group ≥ 60, only a third have received the herpes zoster vaccine.4 What is often disregarded is the lack of education in crucial underserved groups within the United States, such as Hispanics, who often lack the resources to cope with the complications resulting from herpes zoster infection.2

Case Report

The regional blocks were performed with 0.25% bupivacaine and dexamethasone, improving her constant pain from a 9 to a 2/10. Following the block and pain relief, the patient was further educated and agreed to take once-daily duloxetine, leading to further sustained pain relief. The regional blocks were performed with 0.25% bupivacaine and dexamethasone, improving her constant pain from a 9 to a 2/10. Following the block and pain relief, the patient was further educated and agreed to take once-daily duloxetine, leading to further sustained pain relief.

Discussion

Hispanics are one of the most underrepresented for vaccination status, with only a fifth of Hispanics being vaccinated against herpes zoster.8,9 It is difficult to determine a range for Hispanic immigrants who tend to be less trusting of medical professionals.7 This distrust goes beyond herpes zoster, including the most recent COVID-19 vaccine.9,10 The unfortunate side effect of this distrust is the avoidable development of herpes zoster infection and PHN in a population with already limited resources. As in our cases, the patient had debilitating occipital pain that resulted in debilitating pain and was ultimately and effectively treated with a simple, standard, more significant occipital nerve block.

References

1. Marin, M., Güris, D., Chaves, S. S., Schmid, S. & Seward, J. F. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 56, 1–40 (2007).
2. Baalbaki, N. A. et al. A Community-Based Survey to Assess Knowledge, Attitudes, Beliefs and Practices Regarding Herpes Zoster in an Urban Setting. Infect Dis Ther 8, 687 (2019).
3. Hadley, G. R. et al. Post-herpetic Neuralgia: a Review. Curr Pain Headache Rep 20, 1–5 (2016).
4. Services, U. S. D. of H. and H. Healthy people 2010. (2000).
5. Paek, E. & Johnson, R. Public awareness and knowledge of herpes zoster: results of a global survey. Gerontology 56, 20–31 (2010).
6. Lee, T. J. et al. Herpes Zoster Knowledge, Prevalence, and Vaccination Rate by Race. The Journal of the American Board of Family Medicine 26, 45–51 (2013).
7. Hispanic/Latino Health | Office of Minority Health. https://minorityhealth.hhs.gov/hispaniclatino-health.
8. Daniels, D. et al. Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis. Hum Vaccin Immunother 18, (2022).
9. Williams, D. R. & Mohammed, S. A. Discrimination and racial disparities in health: evidence and needed research. J Behav Med 32, 20–47 (2009).
10. Page, K. R. et al. COVID-19 vaccine hesitancy among undocumented migrants during the early phase of the vaccination campaign: a multicentric cross-sectional study. BMJ Open 12, e056591 (2022).