Francesca Galiano
08/08/2022 - Last update 30/12/2022

Mikhail Volokitin, Nazanin Izadi, Ramona Myers, Ndeye Kane Diaw, Susan Milani | Year 2021

Osteopathic Manipulative Treatment of Herpes Zoster Ophthalmicus-Postherpetic Neuralgia


Postherpetic neuralgia

Type of study:

Case report

Date of publication of the study’:



Purpose of the study

  • Objective: to report the efficacy of OMT in resolving the patient’s symptoms in the event of postherpetic ophthalmic neuralgia
  • Measured outcomes: intensity of pain according to Visual Analog Scale (VAS) from 0 to 10 and report of the symptoms


  • Number: 1
  • Description: 74 years old male, caucasian, with severe pain in his right eye and headache following a stressful event of two days before.
    He received a diagnosis of ophthalmic herpes zoster which was followed, as a cure, by the prescription of an antiviral, 5 times a day per 10 days, but without effects. In those days swelling and skin rash developed around the right eye. The patient was treated with topical application of steroids and with the use of steroid-based eye drops. His medical history showed benign prostatic hypertrophy kept under control and past bouts of psoriasis.

At the osteopathic examination, 6 weeks after the onset of symptoms, despite the disappearance of acute symptoms of infection, the patient suffered severe pain (10/10) and skin hypersensitivity at the touch, as well as insomnia for at least two weeks as placing his head on the pillow resulted in excruciating pain. He also felt tingling in his right arm. On the other hand, he did not have any visual problems.

Specifically, the osteopathic structural evaluation revealed extreme skin sensitivity in the area linked to the right greater occipital nerve and an increase in tone in various anterior and posterior muscles in the cervical, upper back and pectoral areas. Furthermore, cervical and sternal mobility was reduced as well as several cranial dysfunctions emerged.

Interventions and evaluations


  • 1 session of OMT
  • OMT: correction of cranial strains, mutual inhibition techniques, myofascial release, balanced ligamentous tension technique and facilitated positional release
  • Various stretching and isometric exercises were recommended for the cervical and upper back muscles


  • 2 weeks after the first and only visit, the pain dropped from 10/10 to 2/10
  • 33 days after the OMT the symptoms disappeared completely
  • The patient experienced a considerable improvement in cervical spine mobility and muscle tone


These effects of OMT – pain reduction and improved mobility – make osteopathy an intervention to be considered in delicate situations where patients do not respond to classical pharmacological therapies and before resorting to more invasive interventions such as surgery.

In fact, OMT can positively influence blood circulation (better nourishment of tissues), lymphatic circulation (better cleansing of the body from toxins and metabolic waste) and the state of the central and peripheral nervous system (less sensitivity to pain and greater sensorimotor coordination.)

Other studies report the efficacy of OMT in case of neuralgia, including trigeminal neuralgia, postherpetic brachial neuralgia and notalgia paresthetica (neuropathy caused by severe itching).

The review of Osteopedia

By Marco Chiera

Strengths: this is the first study showing the usefulness of OMT in the treatment of postherpetic neuralgia and one of the few examining its usefulness in the treatment of neuralgia.

Limits: controlled studies are needed to better understand the significance of OMT, the mechanisms underlying its action and its potential adverse effects; the usefulness of the exercises recommended for pain relief cannot be excluded.

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