5/8 7/10 8/8 6/9 7/8 7/7 8/10 7/9 8/11 5/6 5/5 1 2 − 1 3 1 − 1 − − 2 ＋ ＋ ＋ ＋ − − − − − − − 1 2 3 4 5 6 7 8 9 10 11 72 67 66 58 69 68 63 59 66 68 71 35 28 18 26 21 31 22 19 21 23 26 Dermatomal distribution Rt. T4-T6 Lt. T3-T6 Lt. T10-L1 Rt. C5-C7 Lt. T4-T7 Rt. T4-T7 Rt. T3-T6 Lt. T12-L2 Rt. T4-T6 Rt. T4-T7 Lt. T5-T7 3B 4 3B 4 4 4 4 4 4 3B 3B 156 Korean J Pain Vol. 24, No. 3, 2011 Table 1. Baseline Characteristics of Postherpetic Neuralgic Pain Patients With Chronic Renal Failure Patient Age Duration of pain (m) Stage of chronic kidney disease Duration of hemo-dialysis/CKD (y) Comorbidity Permanent spinal cord stimulation Stage of chronic kidney disease (CKD): Stage 1-kidney damage with normal or increased GFR (GFR ≥ 90 ml/min/1.73 m2); Stage 2-kidney 2 damage with mild reduction in GFR (GFR = 60−89 ml/min/1.73 m ); Stage 3-Moderate reduction in GFR (Stage 3A: GFR = 45−59 ml/min/1.73 m2, Stage 3B: GFR = 30−44 ml/min/1.73 m 2 ); Stage 4-Severe reduction in GFR (GFR = 15−29 ml/min/1.73 m 2 ); Stage 5-kidney failure (GFR = 15 ml/min/1.73 m2) [modified from http://www.nice.org.uk/nicemedia/live/12069/42116/42116.pdf]. Comorbidity: 1. diabetes mellitus, 2. hypertension, 3. cerebrovascular disorders. GFR: glomerular filtration rate. Table 2. Successful 4 Cases of Permanent Spinal Cord Stimulation (SCS) Implantation Patient 1 2 3 4 Follow-up period after permanent SCS implantation (m) 28 41 38 31 Neuropathic medications at final visit day Nortriptyline 12.5 mg qd Nortriptyline 12.5 mg qd Nortriptyline 12.5 mg qd Gabapentin 100 mg t.i.d Gabapentin 100 mg qd Gabapentin 100 mg b.i.d Gabapentin 100 mg qd Tramadol 100 mg qd Tramadol 100 mg qd VAS score at final visit day 2.5 2.9 1.5 1.8 VAS: visual analogue scale ranging from 0 to 10, with being no pain at all and 10 being the worst pain imaginable. Intrathecal steroid injections and topical capsaicin may be effective in PHN (level B evidence). A non-randomized controlled study supports the usefulness of spinal cord stimulation [3,12]. SCS is considered to be of poor value in treating PHN because of deafferentation and scarring of the dorsal horn and dorsal root ganglion. A retrospective study for SCS for pain control of 30 peripheral neuro- pathies revealed that causalgic and diabetic neuropathic pain seem to respond relatively well, whereas postherpetic pain and intercostal neuralgia syndromes seem to respond less favorably to the long-term beneficial effects of SCS [13]. 　　However, Harke et al. [14] insisted that SCS treatment of PHN may offer a worthwhile option in the treatment of pharmacological nonresponders with anatomically intact neural pathways, provided the patients accept such an in- vasive approach. In cases of unbearable herpes zoster pain, this approach may have supportive benefit as well. Iseki et al. [15] reported that excellent outcomes were ach- ieved with SCS for 7 to 10 days on 2 patients who developed PHN within 2 to 3 months of the onset of the condition. They believed that limited-duration SCS for subacute PHN is a useful treatment approach that may prevent pain from progressing to chronic PHN. The other positive result of SCS in the treatment of PHN was introduced by Meglio et al. in 1989. Although positive in only 6 of the 10 patients, the effectiveness of SCS was remarkably stable over time. They therefore recommend a percutaneous test trial of SCS in every case of PHN resistant to medical treatment [16]. The efficacy of peripheral subcutaneous stimulation for the treatment of intractable PHN was recently in- troduced [17,18]. However, because the main pathogno-