Post-Herpetic Neuralgia

After a person recovers from chickenpox, the virus that causes the illness -- the varicella-zoster virus -- lies dormant inside nerve cells in the body. In some cases, the virus can "awaken" later in life and cause a second infection, known as shingles. Shingles can be incredibly painful, since it causes damages to nerves.

Post-Herpetic Neuralgia: A Complication of Shingles

When a person develops shingles, a painful rash develops. Usually, the pain resolves after the shingles has healed. But post-herpetic neuralgia can cause pain that lasts for months or years. The pain is usually localized to the area of the rash.

Who Develops Post-Herpetic Neuralgia?

Approximately 20 percent of people with shingles develop post-herpetic neuralgia. Anyone can develop post-herpetic neuralgia, but the chances of developing it increase with age.

What Are the Symptoms?

• Pain, ranging from mild to severe
• Increased sensitivity to touch
• Sharp pain
• Burning pain
• Throbbing
• Increased sensitivity to temperature changes
• Numbness
• Itching

What Is the Treatment?

• Topical lidocaine Your doctor may prescribe patches that contain lidocaine, a pain-relieving (anesthetic) medication. These are absorbed directly through the skin.
• Antidepressants Certain antidepressants can decrease the pain. The type of antidepressant that is most commonly prescribed is called a tricyclic antidepressant.
• Anticonvulsants Medications that are used to control seizures can be effective treatments for post-herpetic neuralgia. Commonly used anticonvulsants for post-herpetic neuralgia include Neurontin (gabapentin) and Lyrica (pregabalin).
• Capsaicin cream Capsaicin cream is made from the seeds of hot peppers. It is sometimes used for the treatment of post-herpetic neuralgia. However, it causes skin irritation for some people.
• Opioid analgesics Opioid medications such as Oxycodone and morphine can help to decrease the pain.
• TENS Transcutaneous electrical nerve stimulation is a form of treatment that can decrease the pain. Electrodes are applied onto the skin and small electrical currents are delivered.

_Sources:

Choo PW et al. “Risk Factors for Post herpetic Neuralgia”. Archives of Internal MedicineJune 9 1997;157(11(:1217-24

Johnson RW. “Herpes Zoster and Post Herpetic Neuralgia: Optimal Treatment” Drugs AgingFeb 1997;10920:80-94

Freynhagen et al. “Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomized, double-blind, multicentre, placebo-controlled trial of flexible and fixed-dose regimens. Pain. June 2005;115(3):254-63