Postherpetic Neuralgia With Sciatic Nerve Paresis Treated With Peripheral Nerve Stimulator Implantation Device

Sep 30, 2026

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Herpes zoster, or shingles, results from reactivation of the varicella zoster virus in sensory ganglia and commonly resolves within two to four weeks. A subset develops postherpetic neuralgia marked by allodynia and hyperalgesia lasting months to years, with higher risk in older, immunosuppressed patients and those with comorbidities. Oral antivirals may lessen acute severity, yet prevention of neuralgia is limited. This open-access case report describes a 75-year-old woman with severe postherpetic neuralgia in a left sciatic distribution and motor paresis, refractory to multiple medications and brief relief from a lumbar epidural injection, ultimately improving after peripheral nerve stimulator implantation.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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Review began 11/29/2025 Review ended 12/05/2025 Published 12/09/2025 © Copyright 2025 Frunza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98845 Open Access Case Report Postherpetic Neuralgia With Sciatic Nerve Paresis Treated With Peripheral Nerve Stimulator Implantation Device Daniela N. Frunza 1, Christine LeRoy 2, Bijal Sheth 2, Nathaniel Grosu 3 1. Family Medicine, St. Joseph 's Regional Medical Center, Paterson, USA 2. Family Medicine, St. Joseph 's Regional Medical Center, Clifton, USA 3. Biological Sciences, Rutgers University, New Brunswick, USA Corresponding author: Daniela N. Frunza, [dfrunza@scarletmail.rutgers.edu](dfrunza@scarletmail.rutgers.edu) Abstract Herpes zoster, commonly known as shingles, is caused by reactivation of the latent varicella zoster virus in the sensory ganglia. It typically presents as painful grouped vesicles confined to one or two dermatomes. Most lesions resolve within two to four weeks; however, a subset of patients go on to develop postherpetic neuralgia in the area of the original zoster rash, characterized by allodynia and hyperalgesia lasting months or even years. The risk increases with age, immunosuppression, and underlying conditions such as cancer, kidney or liver disease, chronic lung disorders, etc. Although the use of oral antiviral medications during the early stages may reduce the severity and duration of acute herpes zoster, their effect on preventing postherpetic neuralgia remains limited. In this article, we report the case of a 75-year-old female with severe postherpetic neuralgia involving the left sciatic nerve distribution, with resulting motor paresis. After an extensive trial of various oral medication regimens and a lumbar epidural injection, which provided short-term relief, the patient underwent peripheral nerve stimulator (PNS) implantation, with eventual favorable response. Our case report highlights the potential role of using PNS to treat severe postherpetic neuralgia refractory to mainstay conservative treatment modalities. Categories: Neurology, Physical Medicine & Rehabilitation, Pain Management Keywords: atypical shingles presentation, chronic pain management, herpes zoster paresis, herpes zoster sciatica, peripheral nerve stimulator, postherpetic neuralgia, segmental paralysis associated with herpes zoster Introduction Postherpetic neuralgia is a sequela following recovery from an acute outbreak of herpes zoster vesicular eruption. It is characterized by allodynia and hyperalgesia, most commonly between dermatomes T 1 and L2. The pain associated with postherpetic neuralgia can severely affect a person’s quality of life, and in extreme cases, can be debilitating [1] . Though herpes zoster generally affects the head, neck, and trunk, herpes zoster radiculopathy of the sacral segments can be particularly challenging to diagnose and treat, as it can overlap with other spinal pathologies. Currently, first-line management for this condition focuses on maximizing pharmacotherapy with tricyclic antidepressants, gabapentinoids, SNRIs, lidocaine patches, capsaicin topicals, and, if severe enough, opioids. Unfortunately, a subset of patients responds very poorly to the above-mentioned strategies. Several interventions have been documented in the literature, including subcutaneous Botulinum Toxin A injections, transcutaneous electrical nerve stimulation, local triamcinolone injections, intrathecal injections with methylprednisolone, stellate ganglion blocks, dorsal root ganglia destruction, pulsed radiofrequency, spinal cord stimulation, paravertebral blocks, and peripheral nerve stimulation [2] . Currently, there is no uniform consensus regarding the single best interventional treatment. Our case report

FAQs

What causes postherpetic neuralgia after herpes zoster?

Postherpetic neuralgia follows recovery from acute herpes zoster and is characterized by allodynia and hyperalgesia. It arises in the area of the original zoster rash after the vesicular eruption resolves.

Why was the patient’s case challenging to treat?

The case involved severe postherpetic neuralgia in a left sciatic nerve distribution with motor paresis. The patient had progressive worsening despite trials of various oral medication regimens and only short-term relief from a lumbar epidural injection.

What treatment ultimately led to a favorable response?

Peripheral nerve stimulator (PNS) implantation was performed after refractory symptoms. The report highlights PNS as a potential role for severe cases not adequately controlled by conservative approaches.

Sep 30, 2026

Uploaded by Logic