Postherpetic neuralgia

If you've experienced a shingles (herpes zoster) infection, you might encounter postherpetic neuralgia (PHN). About one in five people who’ve had shingles may develop postherpetic neuralgia.

Shingles is caused by the varicella-zoster virus (VZV), which also causes chickenpox. After a person recovers from chickenpox, the virus lies dormant in their nervous system. Decades later, the virus can reactivate and trigger the painful rash and blisters that are symptoms of shingles.

Postherpetic neuralgia is a complication of shingles that causes severe pain in the areas that were affected by shingles. Shingles damages nerves in the areas it affects, scrambling signals to the brain and leading to postherpetic neuralgia.

Postherpetic neuralgia symptoms

If you get PHN, you may endure constant, intense neurological pain on one side of your body, affecting the area where the shingles rash appeared. This pain is often described as sharp, burning, shooting or stabbing. Even gentle touches, like the feel of clothing against your skin, can be painful. Additional postherpetic neuralgia symptoms may include:

• Feeling worn out
• Fever
• Headaches
• Numbness
• Pain accompanied by itching, tingling or aching

Risk factors for postherpetic neuralgia

Factors such as older age, diabetes and having a compromised immune system increase the risk of developing PHN. You may be more at risk for PHN if a blood relative has had it.

Complications of postherpetic neuralgia

The pain from PHN can persist for months, years or become chronic. Complications may include disturbed sleep, lack of appetite, depression, fatigue or impaired concentration. Living with constant pain can significantly impact your ability to work and manage daily activities. It can be draining.

Diagnosis & testing for PHN

If you experience pain in the same area where the shingles rash occurred, especially after a shingles episode, it’s likely to be PHN.

When your primary care provider does a physical exam, they’ll be looking for signs such as these:

• Allodynia (pain due to a stimulus that doesn’t normally provoke pain)
• Altered sensations – either extreme sensitivity or less sensitivity
• Autonomic dysfunction, such as excessive sweating over the involved area
• Scarring on an area that was affected by shingles

Your doctor may recommend polymerase chain reaction (PCR) testing to detect the DNA of the chickenpox virus and confirm an accurate diagnosis.

Postherpetic neuralgia treatment options

Postherpetic neuralgia is notoriously resistant to treatment. Your doctor may use a combination of treatments to manage symptoms effectively.

Medications like anticonvulsants, tricyclic antidepressants and prescription painkillers are commonly used for PHN treatment. Some medications are available in creams or patches for topical application.

Comfort measures for PHN

Using cold packs on the rash or opting for loose-fitting clothing made of cotton or silk can provide relief. Another option is using a TENS (transcutaneous electrical nerve stimulation) device, which applies tiny electrical currents to block pain. Inform your doctor if you use these postherpetic neuralgia treatments for comfort to ensure comprehensive care.

Postherpetic neuralgia prevention

Appropriate vaccinations are key to avoiding PHN. Young children should receive a two-dose chickenpox vaccine. The two-dose shingles vaccine is recommended for adults older than 50. Preventing these infections prevents you from getting postherpetic neuralgia.

Prompt treatment with antiviral medications within two to three days of shingles symptoms can also help prevent a severe case of postherpetic neuralgia.

Staying informed about your health empowers you to take proactive steps in managing your treatment. If you have concerns about postherpetic neuralgia or shingles, consult your doctor for personalized guidance.