Shingles and Postherpetic Neuralgia

After you have had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles. Postherpetic neuralgia (PHN) is the most common complication of shingles. PHN is pain resulting from a herpes zoster outbreak (shingles) along the trigeminal nerve. Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles.

Damaged fibers cannot send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic pain. The most common area to have PHN is along the torso, but pain in the face can also occur. The sensation may be of intense burning or stabbing, and it may feel as if it is shooting along the course of the affected nerve. 

PHN typically starts during the shingles outbreak, but lasts after the rash and blisters have healed. Chicken pox causes shingles later in life. People over the age of 60 have an increased risk of shingles. Treatment for PHN does not cure it, but aims to minimize its symptoms.  

What are the symptoms of postherpetic neuralgia?

Symptoms are usually limited to the area of skin where the shingles outbreak first occurred and may include:

  • Occasional sharp burning, shooting, jabbing pain
  • Constant burning, throbbing, or aching pain
  • Extreme sensitivity to touch
  • Extreme sensitivity to temperature change
  • Itching
  • Numbness
  • Headaches
  • Pain that lasts longer than three months 

Treatment of postherpetic neuralgia

Medication can help to alleviate the pain of PHN,  including anti-seizure medications, antiviral agents, antidepressants, and opioid pain relievers. The pain of PHN can be lessened with anticonvulsants, because they are effective at calming nerve impulses and stabilizing abnormal electrical activity in the nervous system caused by injured nerves. Gabapentin, or Neurontin, and pregabalin, also known as Lyrica, are commonly prescribed to treat this type of pain. Topical patches containing lidocaine, or other pain relievers, are also very effective. 

Complementary therapies

The therapies listed are not proven to help PHN, but you may want to investigate these options. 

  • Vitamin C 
  • Homeopathic treatments 
  • Acupuncture  
  • Cupping 
  • Herbal remedies 
  • Cool packs to soothe the pain 

In most cases, the pain will gradually go away. There is a small risk the pain will return intermittently, or be with you for the rest of your life. However, the majority of patients experience no postherpetic neuralgia pain within one year. 

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