Postherpetic Neuralgia

1 What is Postherpetic Neuralgia?

Postherpetic neuralgia is a shingles complication caused by the herpes zoster or chicken pox virus.

The condition is characterized by a burning pain after the symptoms of chicken pox disappear.

Postherpetic neuralgia primarily affects older people. While it is not curable, medications are available to alleviate the symptoms. 

2 Symptoms

Generally, the symptoms of posthrpetic neuralgia appear only on the area where the shingles first broke out. For most people, this area is the trunk or torso.

The signs and symptoms of Postherpetic neuralgia include:

  • Sensitivity to touch. Even the lightest touching of clothes against the skin is often unbearable for people with this condition.
  • Sharp, burning pain. After the shingles have healed, you may experience sharp, burning pain that can last for 3 months or so.
  • Numbness and itching. Numbness and itching are the less common signs of having this complication.

It is important to go to your doctor immediately at the first shingle breakout. Your doctor may prescribe antiviral drugs to minimize your risk of having postherpetic neuralgia.

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3 Causes

Postherpetic neuralgia is caused by the herpes zoster or chicken pox virus.

The chickenpox virus, once contracted, will never leave your body.

The virus may reactivate if you have a compromised immune system; thus, causing shingles.

Chemotherapy drugs and other medications, as well as old age, are the main causes the virus reactivates.

Sometimes, during a shingles outbreak, the nerve fibers become damaged, hence, causing postherpetic neuralgia.

The chronic pain occurs because the nerve fibers, once damaged, won’t be able to send the right messages to the brain. The wrong messages result in chronic pain.

4 Making a Diagnosis

Most of the time, the doctor does not require any tests to diagnose postherpetic neuralgia.

Your doctor may advise you to see a neurologist or a nerve specialist. A doctor with specialization in treating chronic pain may also be considered.

When making an appointment, ask the doctor or the assistant if there are things you need to do and are not allowed to do.

At times, the doctor will require fasting before doing a test.

It will also help maximize your doctor’s visit by making:

  • a list of your symptoms,
  • writing down the medications and supplements you are taking,
  • major stresses and life changes,
  • as well as your family health history.

Do not hesitate to ask questions and it may help to write all the questions you want to ask your doctor beforehand.

You will also undergo a physical examination in which your doctor may touch the skin and examine the blisters.

5 Treatment

No single treatment relieves postherpetic neuralgia in all people. In many cases, it takes a combination of treatments to reduce the pain.

Here are some of the treatment options for postherpetic neuralgia:

  • Lidocaine skin patches. These lidocaine-infused patches are small and can easily be cut to fit the affected area. These prescription patches contain lidocaine, a known pain-reliever, which when applied directly to the affected area, delivers relief.
  • Capsaicin skin patch. Capsaicin, or chili pepper extract, is applied in bandages, which you can use to alleviate the pain. Capsaicin patches are only available in the doctor’s office and can only be applied by a trained person. The process of application can take two or more hours, but the effect could last up to three months or so. 
  • Anticonvulsants. To reduce the pain, the doctor may also prescribe anticonvulsants, or anti-seizure drugs, such as gabapentin and pregabalin. These drugs help regulate the nervous system’s electrical activity, which is caused by nerve injury.
  • Antidepressants. While they are mainly used to treat depression, antidepressants can also reverse pain by affecting vital brain chemicals. Small doses of antidepressants are usually given to patients with postherpetic neuralgia. These may include nortriptyline, duloxetine, and venlafaxine.
  • Opioid painkillers. For some people, pain can be so excruciating that they’ll need prescription strength painkillers. These include tramadol, oxycodone, and morphine.
  • Steroid injections. A less effective medication for postherpetic neuralgia is steroid, which, in this case, is injected into the spine.

Discuss with your doctor the pros and cons of each available medication. Ask about the possible side effects and complications and their interaction with the drugs you are currently taking, if there’s any.

6 Prevention

One way to prevent postherpetic neuralgia is by getting the herpes zoster vaccine.

This is FDA-approved and doctors usually prescribe it to the elderly.

7 Lifestyle and Coping

Taking the necessary medications can help you cope with the symptoms of Postherpetic neuralgia.

OTC creams that may help alleviate the pain are generally available.

Also, capsaicin cream is highly effective in relieving the pain. Available capsaicin creams are Capzasin-P and Zostrix.

Apart from these, you may also have nonprescription strength lidocaine topical solution to help reduce inflammation of the skin.

8 Risks and Complications

There are several risks and complications associated with postherpetic neuralgia.

You have a higher risk of having postherpetic neuralgia if:

  • You are 50 and older.
  • You had severe rash, combined with severe pain.
  • Experiencing other illness that can compromise your immune system.

Complications include:

  • fatigue,
  • lack of appetite,
  • difficulty sleeping,
  • difficulty concentrating,
  • depression.

The complications typically depend on how severe the pain and how long it lasts.

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