Postherpetic Neuralgia (PHN)
Shingles Nerve Pain After the Rash – Causes, Symptoms, Treatment
Jul 29, 2009
Shingles affects approximately 25% of adults, typically after age 40. Many of those suffering from shingles enjoy a complete recovery within a month of the onset of symptoms. However, half of people over 60 with a shingles outbreak may develop postherpetic neuralgia (PHN), which results in lingering nerve pain that may range from mild to severe.
PHN Causes
For some people, a shingles outbreak damages the nerves, resulting in improper communication from the brain to the skin. Persistent, and often severe, pain results from the damaged nerves and may last months to years after the shingles rash heals. People with a history of neuropathy, a disease of the nervous system, may be more likely to develop PHN.
Postherpetic Neuralgia Symptoms
Shingles, or acute herpes zoster infection, is a reactivation of the varicella zoster virus that causes chicken pox resulting in a rash along a nerve line anywhere on the body. Symptoms of PHN are usually limited to the area of the skin in which the outbreak appeared but may be smaller or larger than the size of the rash associated with the shingles. Symptoms of PHN vary and may include:
- Pain that may be sharp, burning, or aching
- Extreme sensitivity to touch
- Extreme sensitivity to changes in temperature
- Numbness
- Itching
- Headaches
- Muscle weakness, sagging, or paralysis if affected nerves control muscles
Treatment Options for Postherpetic Neuralgia
Although no cure is available for PHN, several treatment options are available. The shingles vaccine has some promising results by preventing or lessening the symptoms of PHN for some people if the vaccine is administered during the early phase of a shingles outbreak. Habits to keep the body healthy may provide some protection from infections, including those from the herpes zoster virus. Many PHN treatments are aimed at pain control, and most people with PHN achieve at least partial pain control with treatment. Combined therapy is often necessary to achieve acceptable pain levels.
- Tricyclic Antidepressants (Elavil, Cymbalta) are usually given in smaller doses than those for depression. These medications affect brain chemicals’ interpretation of pain.
- Anticonvulsants (Neurontin, Lyrica) may help control pain by stabilizing abnormal electrical activity in the nervous system.
- Steroid Injections may be an option after the shingles rash has healed.
- Pain Killers (Ultram, drugs containing oxycodone) may be prescribed, but risks and benefits must be weighed as narcotics can become addictive.
- Transcutaneous Electrical Nerve Stimulation (TENS) delivers small electrical pulses to stimulate nearby nerve pathways.
- Spinal Cord Stimulation works like a TENS unit but is surgically implanted in the space above the spinal cord.
- Peripheral Nerve Stimulation is similar to spinal cord stimulation but the electrode is inserted above a peripheral nerve.
- Lidocaine Skin Patches may be cut to fit the area and applied to the skin for at least twelve hours and seem to provide local, temporary relief. Up to three patches may be used for large areas. These patches should not be applied to the face.
- Capsaicin (Zostrix) is a topical cream made from hot chili pepper seeds. Unaffected areas can become very irritated if the cream comes into contact with unaffected skin, so gloves should be worn during application.
- Psychological therapy (relaxation techniques, biofeedback) may help people to deal with chronic pain.
- Treatment for problems that may stem from chronic pain, such as insomnia and depression, can also help.
Research Studies for Shingles and PHN Treatment
The National Institute of Neurological Disorders and Stroke is conducting research studies to provide more options for treatment of shingles and PHN. Examples of these studies include:
- Looking at ways to increase the activity of macrophages and lymphocytes, the immune cells that seem to combat shingles.
- Considering ways to block viral assembly and exit from nerve cells
- Working toward improved vaccines for shingles and PHN
- Discovering biological differences that may be present in people who do not develop PHN when compared with those who do develop PHN
Seek Healthcare Early for Postherpetic Neuralgia
Aggressive, early treatment for shingles, possibly including the shingles vaccine, tends to produce the best results in preventing or lessening complications of shingles, including PHN. Although no curative treatment is available at this time, people suffering from PHN now have more options for symptom control, which may enable the person to enjoy a pain-free or less painful time while experiencing PHN. Research studies offer hope for better treatments in the future.
Readers may also wish to read about other shingles complications written by Katrena Wells by clicking the name at the bottom of this article.
Information in this article is not intended to be medical advice. Readers should consult their healthcare provider for diagnosis, assessment, and treatment of PHN.
Sources
Department of Pain Medicine and Palliative Care web site
MayoClinic web site
National Institute of Neurological Disorders and Stroke web site
VZV Foundation web site
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