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21KF-001
Prevalence of concomitant thoracic facet joint syndrome in patients with postherpetic neuralgia
Won-Sung Kim, Kyung-Hoon Kim
Department of Anesthesia and Pain Medicine, Pain Clinic, Pusan National University Yangsan Hospital, Kyungsangnamdo, Republic of Korea
Background: Herpes zoster and the following postherpetic neuralgia (PHN) commonly develop in the thoracic dermatome. At the patient’s first visit, the physician usually focuses on inspection of the dermatomal lesions, without palpation of the adjacent spine due to the extreme tactile allodynia. This study evaluated the prevalence of the coexistence of thoracic facet joint syndrome (TFJS) in patients with thoracic PHN.
Methods: A retrospective study enrolled thoracic PHN patients from a 10-year period. They were divided into 2 groups, PHN patients with or without TFJS, according to history, physical examination, and dual diagnostic medial branch blocks. The prevalence of TFJS, the affected side of TFJS compared to PHN, and the interval from the first visit to the confirmation of TFJS were evaluated in TFJS group. The age, sex ratio, and precipitating factors were compared between the groups.
Results: Twenty-seven (20.8%, M/F = 11/16) of 130 patients with thoracic PHN had concomitant TFJS (ipsilateral/contralateral/bilateral = 10/1/16). Fourteen of 27 (51.9%) TFJS patients were diagnosed as TFJS at their first visit. There was no difference in the mean age, sex ratio, interval between the rash onset to the first visit, and precipitating factors in developing TFJS between groups with and without TFJS.
Conclusions: One fifth of PHN patients had concomitant TFJS, and ipsilateral TFJS to the PHN affected involved about 1/3 of them. Instead of up-titration of medication for neuropathic pain, it is necessary to turn attention to comorbid referred pain from TFJS.

Key Words: Attention; Demography; Herpes zoster; Palpation; Prevalence; Postherpetic neuralgia; Posture; Radiating pain; Referred pain; Skin rash; Tactile allodynia; Zygapophyseal joint.