Postherpetic neuralgia

Postherpetic neuralgia (PHN) is sometimes triggered after you’ve had a shingles (herpes zoster) infection. About one in five people who’ve had shingles will get postherpetic neuralgia.

Shingles is a disease that affects some people decades after they’ve had varicella-zoster virus (VZV) – more commonly known as chickenpox. After you recover from chickenpox, the varicella-zoster virus lies dormant in your nervous system and sometimes gets reactivated to cause the rash, blisters and pain associated with shingles.

Postherpetic neuralgia is a complication of shingles that causes pain in the areas that have been affected by shingles. Shingles damages nerves in the area, which causes the pain from PHN.

Postherpetic neuralgia symptoms

People who have postherpetic neuralgia have constant, intense neurological pain on one side of the body. This severe pain typically affects the same area where the shingles rash previously appeared. The pain is described as burning, shooting, sharp or stabbing. It may hurt to be touched – even the touch of clothing against your skin.

Other postherpetic neuralgia symptoms:

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

Postherpetic neuralgia risk factors

Some of the risk factors for PHN are older age, having diabetes and having a compromised immune system. If you have a blood relative who’s had postherpetic neuralgia, you may be more at risk for it.

Postherpetic neuralgia complications

The pain from postherpetic neuralgia can last for months, years or even become chronic. In addition, there can be complications such as:

• Depression
• Fatigue
• Disturbed sleep
• Lack of appetite
• Impaired concentration

Because of the potential for complications and the possibility of it becoming a chronic condition, postherpetic neuralgia can be debilitating for some people. Living with constant pain can make it hard to work or even take care of daily activities.

Postherpetic neuralgia diagnosis

The diagnosis of postherpetic neuralgia may be evident to your doctor. If the pain happens after a bout of shingles and is in the same area where the shingles rash was, chances are good that it’s PHN.

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

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

In some cases, your doctor may recommend testing to verify the diagnosis. Using polymerase chain reaction (PCR) to test for the DNA of the chickenpox virus confirms an accurate diagnosis of postherpetic neuralgia.

Postherpetic neuralgia treatment

Postherpetic neuralgia is resistant to treatment. Your doctor may use a variety of treatments to manage your symptoms.

Medications used to treat PHN include anticonvulsants, tricyclic antidepressants and prescription painkillers. Some medications are provided in creams or patches to apply to the skin.

Comfort measures for PHN

Some people find it helpful to use cold packs on the rash to help manage PHN pain. Wearing loose-fitting clothing made of cotton or silk may also be more comfortable.

Another option is using a TENS (transcutaneous electrical nerve stimulation) unit. These devices apply tiny electrical currents to the painful areas of skin to help block pain.

Let your doctor know if you use any of these postherpetic neuralgia treatments for comfort. It’s important for them to be able to consider the whole picture of your care.

Postherpetic neuralgia prevention

The best way to avoid postherpetic neuralgia is by getting the appropriate vaccinations. A series of two doses of chickenpox vaccine is recommended for young children. The two-dose shingles vaccine is recommended for adults older than 50. If you don’t get the initial infections, you won’t develop postherpetic neuralgia.

Getting prompt treatment for a shingles infection can also help prevent a bad case of postherpetic neuralgia. If your doctor prescribes antiviral medications within two to three days of seeing symptoms of shingles, it helps keep PHN at bay.

If you have concerns about chickenpox, shingles or postherpetic neuralgia, contact your primary care provider for individualized advice.