Post-Herpetic Neuralgia

What is post-herpetic neuralgia?

Shingles (more formally known as herpes zoster) is a viral infection that is caused by the same virus that causes chickenpox. Adults who had chickenpox as children may inexplicably experience a shingles outbreak later in life. This infection brings with it a painful, persistent rash. After the rash disappears, the threat of post-herpetic neuralgia remains. Post-herpetic neuralgia often results in quality-of-life altering pain.

This type of pain is typically located at the same site on the body where the shingles outbreak initially occurred — usually one side of the back, chest, or stomach. The most common symptom is a burning pain that keeps sufferers from sleep and diminishes appetite.

Other common symptoms include:

• Burning, sharp, and jabbing pain
• Itching or numbness
• Muscle weakness or paralysis
• Sensitivity to any touch

As with the shingles virus, some people experience mild symptoms. Unfortunately, many find the symptoms of shingles and the post-herpetic neuralgia that follows very painful and frequently debilitating.

What causes it?

For those who did not receive a chickenpox vaccination as a child, post-herpetic neuralgia may develop after a shingles outbreak. The condition occurs when nerves are damaged during a shingles outbreak. The nerves become confused and no longer communicate properly between the skin and brain. The result is sharp pain that may be so severe the lightest touch can cause agony.

Do note that shingles patients who are able to see a physician within the first 72 hours of the signature rash appearing and start a course of antivirals are half as likely to develop post-herpetic neuralgia. Early treatment is crucial.

How to prevent post-herpetic neuralgia

Nearly 100% of people over 40 years old in the U.S. carry the dormant chickenpox virus, but there is good news. Shingles and related post-herpetic neuralgia are entirely preventable with a vaccination.

Since 2006, a shingles vaccine has kept many older adults free from outbreaks. The U.S. Centers for Disease Control and Prevention (CDC) report that a clinical trial involving thousands of adults 60 years old or older showed Zostavax — the first shingles vaccine — reduced the risk of shingles by just over half (51%) and the risk of post-herpetic neuralgia by 67%. The vaccine was most effective in people age 60–69 but also provided some protection for older groups.

Recent research continues to prove the effectiveness of Zostavax in preventing shingles and post-herpetic neuralgia, with protection that lasts for approximately five years. And another bonus to receiving the shingles vaccination? New research indicates that Zostavax decreases the risk of stroke by 20% in adults under 80 (and 10%  for those over 80).

A newer shingles vaccination, Shingrix, is proving more effective in clinical trials but does come with an increased risk of side effects at the injection site. The CDC has begun to recommend Shingrix over Zostavax for adults over 50, but talk to your doctor about which might be best for you.

How to treat post-herpetic neuralgia

There is no specific test for post-herpetic neuralgia, nor is there one single cure. Your doctor will take a full medical history, including your vaccination record for chickenpox. A physical examination of any existing rash, or a shingles outbreak and accompanying symptoms, may be enough to confirm the presence of this condition.

The best treatments are customized for each patient and may be entirely different from one person to the next. Medications can include antidepressants, anticonvulsants, pain-relieving skin patches, capsaicin cream, and topical pain-relieving creams. Other pain-relief therapies can help during painful periods.