What is Post Herpetic Neuralgia?
Post Herpetic Neuralgia Explained by Las Vegas, Summerlin, and Henderson Nevada’s Top Pain Doctors
Post herpetic neuralgia is a neuropathic pain affecting many different areas of the body, and is believed to be a complication of the virus that causes shingles or chickenpox. Given the development of the chickenpox vaccination, studies have shown that an individual’s risk for developing post herpetic neuralgia can be reduced by as much as 67% by receiving this vaccine. Indeed, evidence has shown that this vaccine is even effective in protecting older adults from developing an outbreak as a result of the herpes zoster virus.
While the symptoms of post herpetic neuralgia are typically focused within the area where the original shingles outbreak occurred, in some cases, the pain may spread to other parts of the body as well. Further, the pain associated with post herpetic neuralgia may range from mild to very severe and may be acute or chronic in nature. Patients with post herpetic neuralgia may not be able to tolerate the sensation of touch on the affected area, even from contact with light, soft clothing. Emotional stress has also been found to exacerbate symptoms.
Causes of Post Herpetic Neuralgia
Nerve damage that causes post herpetic neuralgia is believed to be the result of a shingles outbreak. Shingles is a condition associated with rash, blisters, excessive nerve inflammation, and even nerve damage caused by the herpes zoster virus (the same virus that causes chickenpox). In general, symptoms of shingles are expected to improve within several weeks; however, when the neuropathic pain persists, even after the rash and blisters associated with the original shingles outbreak have cleared, it is termed post herpetic neuralgia.
Watch this Video About Post Herpectic Neuralgia
The persistent pain symptoms of post herpetic neuralgia occur as a result of damage to the nerve fibers following a shingles outbreak. This damage causes the nerve bundles to send exaggerated pain messages from the skin to the spinal cord and brain. Indeed, these neurological systems can persist for months and even years, causing the patient to experience chronic symptoms of severe and excruciating pain. This pain can be severe enough in some cases to cause disturbances in sleep and appetite.
Presently, no cure for post herpetic neuralgia exists. As noted, vaccines can help lower the risk of developing an outbreak. In general, symptoms of post herpetic neuralgia remit over time.
Treatments for Post Herpetic Neuralgia
There is no specific cure for post herpetic neuralgia; however, there are a number of available treatments to assist patients in managing the painful symptoms associated with this condition.
For patients with chronic and severe neuropathic pain owing to post herpetic neuralgia, TENS units, which are devices that deliver a very mild electrical stimulation to the affected area, have also received some support for their usefulness in providing pain relief. Additionally, there is some indication that patients can experience a significant reduction in pain with spinal cord stimulation. This procedure involves implanting a device near the spinal column that delivers electrical impulses to control the transmission of pain signals from the nerves within the spine.
In terms of pharmacotherapy, there are currently no medications that have been approved for the treatment of post herpetic neuralgia, though several medications are believed to provide patients with some relief. Capsaicin skin patches are believed to provide some relief for the neuropathic pain associated with post herpetic neuralgia. Some anticonvulsants, such as gabapentin, are often used in alleviating pain that accompanies nerve damage. Further, there are a number of medications that were originally developed to alleviate symptoms of depression that have also been shown to be affective for neuropathic pain. Individuals, whose pain is severe and does not respond well to over-the-counter remedies, may wish to speak to their doctor about prescribing an opioid medication to help manage the pain.
Post herpetic neuralgia is a chronic pain condition resulting from nerve damage following an outbreak of shingles. The pain associated with post herpetic neuralgia is often limited to the site of the original shingles outbreak; however, in rare cases, it can be experienced as more general, wide spread pain. There is currently no cure for post herpetic neuralgia, though a number of treatment options are available for managing the symptoms of pain. Patients are encouraged to speak with their physician about the course of their condition in order to determine the treatment plan that is right for them.
- Barbarisi M, Pace MC, Passavanti MB, Maisto M, Mazzariello L, Pota V, Aurillo C. Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clin J Pain. 2010;26(7):567-72.
- Derry S. Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2013;28.
- Gan EY, Tian EA, Tey HL. Management of herpes zoster and post-herpetic neuralgia. Am J Clin Dermatol. 2013;14(2):77-85.
- Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2013;28.
- Harden RN, Kaye AD, Kintanar T, Argoff CE. Evidence-based guidance for the management of postherpetic neuralgia in primary care. Postgrad Med. 2013;125(4):191-202.
- O’Connor KM, Paauw DS. Herpes zoster. Med Clin North Am. 2013;97(4):503-22.