Possible role of acupuncture in the treatment of post-zoster limb pain and paresis: Case report and literature review

Background: Associations of inflammation with occurrence of pain and paralysis in shingles have been well documented. Thus, the anti-inflammatory effect of acupuncture might improve or hasten pain relief and motor recovery in patients with shingles-associated pain and paralysis. Objective: To describe the possible role of acupuncture in motor deficit recovery and pain relief in a male patient with post-zoster neuralgia and limb paralysis. Case Summary: The patient developed burning pain over his right shoulder followed by red painful vesicles over the right arm and right shoulder weakness. Despite hydrocodone, rofecoxib and gabapentin, these symptoms persisted. His physical examination and laboratory tests were normal except for the deltoid muscle strength of 1/5, and the C4 dermatome rashes. He received a 10-day course of intravenous acyclovir and prednisone, massage therapy, physical and occupational therapy. The rashes resolved. The pain-10/10 in severity-and paralysis persisted, even one month post-hospital discharge. In line with the Traditional Chinese Medicine method, 3-4 acupuncture treatments per week were administered to the patient for 3 months. By the end of the 1st month of treatment, the patient muscle strength was 4/5 and his pain was 3/10. By the 3rd month, his muscle strength was 5/5 and his pain was down to 1/10. At the 18-month follow-up, he had normal muscle strength and was off all analgesic drugs. Conclusion: The usefulness of acupuncture in the treatment of shingle-related neuropathic pain and motor paralysis merits further study in a large, controlled clinical trial.