A 32-year-old female patient was referred to the pain unit for consultation at the outpatient clinic due to pain secondary to herpetic affection of the ophthalmic branch of tramadol (50/8h, left).
Its antecedents include episodes of recurrent uveitis and uveitis that have been labelled as herpetic.
In the first consultation (2001), the patient complained of left eye pain of about 3 months of evolution, with paroxysmal episodes that increased with certain stimuli such as wind, cold or dry eye.
Physical examination showed no neurological deficits.
Pain is rated by the patient with a maximum visual analog scale (VAS) score of 7-8 (during paroxysms) and a minimum of 2.
The diagnosis was postherpetic neuralgia of the left cranial nerve branch.
Treatment with gabapentin and tramadol is started in progressive doses, without achieving good pain control and development of side effects in the form of vomiting and drowsiness.
A series of drug rotations (amitriptyline, tomato) were performed at different doses that did not produce any improvement in pain or adverse manifestations.
After patient acceptance, treatment with low frequency electroacupuncture (EA) was started (2-4 Hz/s), the intensity used was that accepted by the patient as tolerable.
It was applied in fortnightly sessions of 30 minutes duration.
The chosen points were: yintai, bilateral taiyang, 18 bilateral ID, 4 bilateral IG, 3 bilateral H, initially combined with gabapentin (300 mg/ 12 h).
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After 6 sessions of treatment, the patient reported better analgesic control and better tolerance to drugs, reason why gabapentin was increased (900 mg) and paroxysmal administration of tramadol (25 mg every 6-8 hours).
AE sessions were held weekly.
This was followed by better analgesic quality, but vomiting.
It was decided to discontinue tramadol and gradually increase gabapentin during 2 months (2,400 mg/24 h).
With this new therapeutic plan a patulatine control of paroxysmal crises was obtained, both in intensity, frequency and duration.
After 3 months of clinical stability, the patient barely complained of continuous pain, paroxysmal crises had decreased in frequency and intensity, and had better tolerance to sleepiness.
Gabapentin was progressively reduced over 3 months until its suspension.
At the end of this period, the patient reported only paroxysmal seizures of lower intensity (VAS 4-5) and with intercrisis intervals of 7-10 days.
These were managed with low doses of tramadol solution (25 mg), which was effective for pain control, but accompanied by nausea, reason why the patient stopped using it.
After a period of 6 months with weekly sessions of AD and acceptable control of the clinical picture began a patulatinized disease.
Currently, the patient is under treatment in our unit (multiple consultation January 2009), with only AE sessions every 30-45 days, without any other type of medication, with adequate pain control.
Analgesic control has been tried every 60 days for acupuncture sessions, but the quality of analgesic control is worse.
