Postherpetic Neuralgia and Pain After Shingles

Treating this painful shingles complication

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Postherpetic neuralgia (PHN) is a painful condition that occurs as a complication of shingles, which is caused by the same virus that causes chickenpox: varicella-zoster. It affects the nerve fibers and skin long after shingles has gone away and causes more pain and burning. There are three types of postherpetic neuralgia:

  • Acute herpetic neuralgia. Pain accompanies the rash and persists for up to 30 days after the start of the rash.
  • Subacute herpetic neuralgia. Pain persists for 1 to 4 months after the start of the rash.
  • Postherpetic neuralgia. Pain persists for more than 4 months after the start of the rash.

Causes of Postherpetic Neuralgia

If you had chickenpox as a child, the shingles virus - varicella-zoster - is already inside you. It remains dormant for many years until it travels back through the nerves and into the skin, causing a shingles rash. PHN occurs when nerve fibers become damaged during a shingles outbreak. The damaged nerve fibers lead to chronic pain that persists for months or even years.

PHN, a complication of shingles, can actually lead to more complications, including:

Postherpetic Neuralgia Risk Factors

The risk of developing PHN increases with age. The majority of people affected are older than 60. One study found that amongst people ages 60 to 69 who developed shingles, 6.9 percent developed PHN.

For people over 70 years of age who developed shingles, 18.5 percent developed pHN.

In addition to age, other major risk factors include having experienced more severe pain with the shingles rash and an overall more severe shingles rash. You are also more likely to develop PHN if you had shingles on your face or trunk.

A weakened immune system is actually not a risk factor of PHN.

Symptoms of Postherpetic Neuralgia

Both shingles and PHN can cause pain so severe that it interferes with your life. Symptoms of PHN are typically limited to the area where the shingles rash occurred. Specific symptoms include:

  • Burning sensation in the area where the rash has healed
  • Pain brought on by normally non-painful stimuli such as a light touch
  • Itching
  • Areas of numbness and difficulty sensing temperature and vibration

Treatment of Postherpetic Neuralgia

You should see a doctor upon the first sign of shingles, as well as symptoms of PHN. PHN diagnosis typically doesn't require any testing. The treatment of PHN is complex and often requires multiple medications. Unfortunately, there is no single treatment that works for all people. Many people have to use a number of treatments to relieve symptoms. They include:

  • Lidocaine and capsaicin patches
  • Anticonvulsants (gabapentin and pregabalin)
  • Antidepressants (nortriptyline, duloxetine, and venlafaxine)
  • Opioids (tramadol, oxycodone, and morphine)
  • Steroid injections

Capsaicin cream is a popular over the counter PHN treatment. Capsaicin is a natural derivative of chili pepper seeds and relieves pain and itching.

How to Prevent Postherpetic Neuralgia

Shingles aren't completely preventable, but there are a few things you can do to decrease your chances of acquiring it and its complications:

  • See your doctor as soon as you notice shingles symptoms.
  • Get the shingles vaccine. It greatly decreases your risk of developing shingles, PHN, and other complications.


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