Post Herpetic Neuralgia

Most rashes come and go, with light symptoms and only mildly interfering with daily activities. However, there are some rashes that not only cause extreme pain, but leave behind painful feelings even after the rash has resolved itself. In this case, those who suffer from shingles can also suffer from a complication of shingles, called post herpetic neuralgia. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, and Chula Vista areas can help patients not only manage their shingles symptoms, but also manage their post herpetic neuralgia symptoms so it doesn’t completely disrupt their life, potentially for years. 

What is Post Herpetic Neuralgia?

Post herpetic neuralgia (PHN) is a complication of the shingles infection, also known as herpes zoster. Shingles is a viral infection that is caused by the same virus that causes chickenpox. It occurs most often later in life and causes a painful rash that usually occurs on one side of the body. As the rash and blisters go away with treatment, there are chances that pain remains, which is post herpetic neuralgia. 

Post herpetic neuralgia is usually located on the same side and in the same area as the shingles outbreak occurred, which is usually on the side of the back, chest or stomach. The pain can be constant or can “come and go.” Patients most often report a debilitating pain that keeps them from being able to sleep, as well as a decrease in appetite, but other symptoms could include: 

• Sensitivity to any touch
• Muscle weakness or paralysis
• Itching or numbness
• Jabbing, sharp, achy or burning pain

Is it possible, as with the shingles virus, that patients do not experience extreme pain after the shingles virus has been treated and goes away. However, many patients do experience debilitating pain that greatly reduces their quality of life if they do happen to suffer from post herpetic neuralgia. 

Symptoms associated with post herpetic neuralgia can last for weeks or months, or in some cases, even years after the shingles outbreak occurred. The pain can be so severe that it disrupts quality of life and can keep people from being able to perform the simplest of tasks or activities. Researchers aren’t yet sure as to why some people suffer from post herpetic neuralgia after the shingles virus, while others do not. 

What Causes Post Herpetic Neuralgia?

Post herpetic neuralgia is a result of nerve fibers that were damaged during a shingles outbreak. The nerve fibers located in the skin of the affected area are confused and now send incorrect and exaggerated pain signals to the brain, meaning that even the slightest touch is felt as excruciating pain. 

It is important to note that early treatment for the shingles virus is crucial for reducing the chances of suffering from post herpetic neuralgia. Patients who sought help from a pain management specialist within three days of first noticing symptoms of shingles, and who began treatment right away, were half as likely to develop post herpetic neuralgia. In general, about one in five people who recently had shingles will be diagnosed with post herpetic neuralgia. 

Who is at Risk for Getting Post Herpetic Neuralgia?

In addition to properly treating – or not – the shingles virus in the first place, additional factors that increase a person’s chance of developing post herpetic neuralgia include: 

• Age: the change of developing post herpetic neuralgia increases with age. If you’re older and develop shingles, you’re more likely to develop post herpetic neuralgia and suffer from it longer and with more intense symptoms than a younger person. 
• Weakened immune system: the immune system naturally weakens with age, which allows for the dormant varicella-zoster virus (the same virus that causes chicken pox) to become active and cause shingles. There are other conditions that can decrease the immune system, which can increase the chance of developing shingles and the post herpetic neuralgia, including cancer, chronic infectious diseases, receiving an organ transplant, and more. 
• Severity of shingles: more severe cases of shingles can lead to a higher chance of developing post herpetic neuralgia
• Symptoms prior to shingles: patients who experienced a painful, itchy and tingling feeling before the shingles rash have a higher risk of post herpetic neuralgia
• Delaying shingles treatment: waiting more than 72 hours to begin treatment for shingles increases the chances of developing post herpetic neuralgia

Can You Prevent Post Herpetic Neuralgia?

The good news is that shingles and post herpetic neuralgia are completely preventable by taking a vaccine. This helps nearly every single person over the age of 40 who carry the dormant chickenpox virus avoid a painful and debilitating rash. 

Since 2006, the Zostavax vaccine (the first shingles vaccine) has helped many older adults avoid outbreaks. In addition to reducing the risk of shingles in more than half of American adults, the vaccine also reduces the risk of post herpetic neuralgia, and even stroke, for up to five years. 

There is now another shingles vaccine called Shingrix, which has proven more effective, but does have a higher risk of infection at the injection site. The vaccination is given in two doses, two to six months apart, and is 90% effective at preventing shingles and post herpetic neuralgia for up to four years after vaccination. 

The best way to determine which vaccine could benefit you most is to talk to your healthcare provider.  

What are the Treatment Options for Post Herpetic Neuralgia?

It’s important to partner with a trained pain management specialist who can provide a physical exam and review your medical history, including which vaccinations you’ve taken, to determine if you have post herpetic neuralgia and what the best treatment might be. Most treatment options include antiviral medications that help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching, and reduce pain symptoms after the sores have healed. 

For mild pain, your provider might recommend acetaminophen or NSAIDs, or creams and patches. For more severe pain, antidepressants and antiseizure medications, as well as botulinum toxin injections, could help relieve pain. 

There is no simple or single solution to treat post herpetic neuralgia, which is why it’s important to seek medical attention from a trained pain management specialist. The California Pain Consultants team in the Escondido, El Centro, La Mesa, San Diego, and Chula Vista areas can help to diagnose and treat both shingles and post herpetic neuralgia, with a goal to help their family of patients experience less debilitating symptoms for a shorter period of time. Please schedule an appointment today so  we can begin the treatment process.