Postherpetic neuralgia (PHN) is a nerve-related pain syndrome that occurs after an outbreak of varicella zoster virus (shingles), which is the same virus that causes chicken pox. PHN causes severe pain of the affected body region.
How common is postherpetic neuralgia?
Among people age 60 years and younger, the risk of PHN three months after the onset of the zoster rash is 1.8%. For patients age 60 years and older, the risk of PHN increases to 3.3%, with most patients having moderate pain. Overall, PHN affects around 10% of the general population.
What causes postherpetic neuralgia?
Varicella zoster virus (VSV) is the same virus that causes chicken pox. After an infection of chicken pox, the virus lies dormant inside the nerve cells. Years later, certain triggers can reactivate the virus, causing a shingles outbreak. After shingles, the nerves remain irritated, leading to postherpetic neuralgia. The virus travels along nerve fibers causing pain, and when the virus reaches the skin it produces rash and blisters. Long after blisters and rash heals, the pain can linger.
What triggers an outbreak of shingles?
Common known triggers include illness, stress, advanced age, certain medications, and decreased immune system function. Not everyone will have a reactivation of the virus, but the older you are, the greater the chance you will develop postherpetic neuralgia.
What are the signs and symptoms of postherpetic neuralgia?
The pain (neuralgia) is usually limited to the region of skin where the initial shingles outbreak occurred. The symptoms include:
- Jabbing, sharp, burning, gnawing, and/or aching pain
- Extreme sensitivity to temperature changes and light touch
- Numbness, tingling, itching, and/or electric-shock sensations
What is the treatment for postherpetic neuralgia?
Without treatment, PHN usually eases gradually and goes away. However, more than 50% of people with this condition have symptoms that persist beyond 3 months. Doctors often use a combination of treatment modalities for postherpetic neuralgia. Options include:
- Topical lidocaine skin patches – Lidoderm patches are small adhesive patches that contain a topical pain reliever (lidocaine). These patches are applied over the painful skin to offer relief of discomfort.
- Topical capsaicin cream – Derived from hot chili peppers, this medication offers relief of pain by interfering with pain signals. It is applied to the affected skin several times each day.
- Antidepressants – Certain brain chemicals (norepinephrine and serotonin) play a role in how the brain interprets pain. These drugs are used for PHN, including nortriptyline and certain SSRIs.
- Anticonvulsants – Neurontin and Lyrica are two anti-seizure drugs that help with nerve-related pain. They work by stabilizing abnormal electrical activity in the nervous system, which is caused by injured nerves.
- Epidural steroid injection – This involves injecting the space around the spinal cord with a corticosteroid to decrease nerve inflammation and reduce pain.
- Transcutaneous electrical nerve stimulation (TENS) – This intervention involves the placement of electrodes over the painful skin. Tiny, electrical impulses are sent via a device to these electrodes, which interferes with pain signals and stimulates the production of endorphins (body’s natural pain relievers).
- Spinal cord stimulation (SCS) – This device is surgically implanted beneath the skin. Wires run from the device and attach to surgically placed electrodes along the spinal column. Mild, pleasant electric current is delivered to the spinal cord, which blocks pain signals. In a recent medical study, researchers followed patients with PHN who were treated with SCS for 4 years. They found that SCS was quite helpful for reducing pain.
- Intrathecal pump implant – For severe pain, a pain pump can be implanted in the body. A catheter will run directly to the spinal cord to deliver narcotic pain medication. According to a recent medical study, the success rate for this pump was 86% for intractable pain, and it reduced reliance on oral medications.
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