Postherpetic Neuralgia

If you have ever had shingles, you may already know what postherpetic neuralgia is. Postherpetic neuralgia or PHN, consists of lingering nerve pain that continues after a case of shingles. For some, the pain may continue to come and go for quite some time.

Shingles happens when the same herpes virus that causes chicken pox infects the nerves. The varicella-zoster virus affects around 1 out of 5 people. This rash can affect anyone, but most commonly those over 50 years old. The pain that occurs with shingles usually disappears with the rash itself, but postherpetic neuralgia lingers on for a period of time.

What Causes Postherpetic Neuralgia?

It all begins with the very same herpes virus that causes chicken pox, varicella-zoster. Once you get Chicken poxas a child, this virus can remain dormant in the nervous system for the rest of your life. The immune system keeps the virus dormant and prevents the body from becoming re-infected with Chicken Pox. There is a slight chance that in later years the virus may become active again and cause what is known as shingles.

Shingles is an infection of the nerves and skin with the varicella-zoster virus that has been reactivated. It usually affects nerves in the chest area and abdomen on one side of the body only. The infection usually lasts around 2 to 4 weeks and after the rash clears the pain subsides.

Postherpetic neuralgia causes continuing nerve pain that does not go away when the rash clears. This is because the virus causes some nerve damage to the affected nerves. They begin to send out random pain signals back to the brain that feel like burning and pounding around the affected area.

What Are the Symptoms of Postherpetic Neuralgia?

The symptoms of postherpetic neuralgia occur in the same region as the shingles rash. The symptoms of this condition include:

• Pain that is constant consisting of throbbing, aching, or burning, pain that is intermittent including stabs, burning, pain jolts or jabs
• Sensitivity to being touched, temperature changes
• Headaches
• Numb sensation
• Itching
• Weakness in the surrounding muscles
• Less commonly, paralysis in the surrounding muscles
• Insomnia
• Fatigue
• Problems with daily functions i.e. getting dressed, taking a bath, brushing hair

When to See a Doctor

If you think you might have shingles, see a doctor right away. You may notice the pain of shingles prior to the rash appearing. If you receive anti-viral medication within the first 72 hours of illness, the duration and pain will be shortened. This will also help reduce the risk of postherpetic neuralgia.

What Are the Treatments for Postherpetic Neuralgia?

There are a few different treatments that can help relieve the pain. Not all treatments are effective for everyone that suffers from PHN. Sometimes doctors need to combine one or two of the following treatments:

• Lidocaine patches – Lidocaine patches are like stick on bandages that have a gel formulation of lidocaine. This is the very same medicine used to numb parts of your body. You can cut the patches to fit the area that needs pain relief. These patches can be prescribed by your doctor. The pain relief is only temporary.
• Capsaicin patches – Capsaicin is the compound in chili peppers that has been found to be a very effective pain reliever. It is infused into a stick on patch that can deliver the capsaicin to the site of nerve pain. You can also find it in cream form to rub on the area as needed. If used over a few weeks’ time, it can lower the pain level considerably. Some people may not tolerate capsaicin due to a sensation of burning on the skin. The cream is available over-the-counter. The patches need to be applied by a doctor in the office with lidocaine, because these patches are a very high concentration. However, people have reported low pain levels with capsaicin patches for up to three months.
• Opiate pain medications – If the pain is unbearable, the doctor may need to give you and opiate pain medication such as Percocet, Ultram, or even morphine. These can cause severe drowsiness, dizziness, and are possibly addictive if taken too long. The doctor will only give you enough for the shortest amount of time possible to help control pain.
• Anticonvulsants – Postherpetic neuralgia pain can be successfully treated with anti-seizure medications. This is because they tend to work directly on the nerves to help them work properly. The common medications used for this are Neurontin (gabapentin), Lyrica (pregabalin), and other seizure medications. These will help reduce the sensation of pain and burning. There are side-effects that can make you feel sleepy, foggy, feet swelling, and unsteady.
• Antidepressant medications – There are some antidepressant medications that can help reduce the amount of pain that you feel with PHN. They are usually given in very small doses. Doctors use Cymbalta, Effexor, Pamelor, and amitriptyline. They have a few side-effects includingmouth dryness, feeling tired, dizziness, and weight gain.

Can Postherpetic Neuralgia Be Prevented?

Postherpetic neuralgia is not always preventable, but early treatment with an antiviral drug may help reduce the risk of developing it. The antiviral drug needs to be taken within the first 72 hours of shingles to be completely effective. Antiviral drugs also reduce the risk of other complications from shingles.

There is an even greater chance of preventing this condition if you receive the shingles vaccination. This will help prevent you from getting shingles in the first place, therefore reducing your risk for PHN. Zostavax, the vaccine for shingles can decrease your risk of contracting shingles by around 70 percent. It is recommended that all adults over the age of 50 receive the vaccine even if they have had shingles.