Tramadol for management of acute severe herpetic pain after liver transplantation

Abstract

A 68-year-old woman underwent living-donor liver transplantation and received immunosuppressive therapy. She developed severe herpes zoster in the left fifth thoracic nerve region and visited the department of dermatology. The severe pain persisted despite antiviral treatment; therefore, she was referred to our department for relief from herpetic pain and was administered tramadol (75 mg/day) on the ninth day after the onset of symptoms. The patient had received lidocaine and nortriptyline concurrently for pain suppression in the acute phase. Her pain reduced gradually, and no prolongation or recurrence of pain was observed after discontinuation of tramadol. Immunocompromised patients who undergo organ transplantation often develop herpes zoster infection and subsequent postherpetic neuralgia. Although such patients require intensive therapy, the available treatment options are limited. Tramadol administration could thus be beneficial in patients contraindicated for neuraxial block therapy and those experiencing acute herpetic pain that shows a poor response to nonsteroidal antiinflammatory drugs.