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What is Postherpetic Neuralgia?


The pain remaining after an acute episode of shingles is called postherpetic neuralgia (PHN). Shingles typically affects people ages 50 years or older. More than half of those with shingles will go on to develop postherpetic neuralgia (PHN) or after-shingles pain

Shingles is due to a second outbreak of the herpes varicella-zoster virus which initially causes chickenpox. During the initial chickenpox infection, some of the HZ virus remains dormant inside some of the nerve cells. Years later, the virus reactivates resulting in shingles.

Pain is a key symptom of shingles. It should disappear as you heal from the shingles episode. Most cases of shingles heal within a month. If the pain lingers for more than a few weeks after the rash is healed, then postherpetic neuralgia is diagnosed.

PHN pain results from nerve damage caused by the shingles virus. The symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred. They may include:

* Sharp and jabbing, burning, or deep and aching pain
* Extreme sensitivity to touch and temperature change
* Itching and numbness
* Headaches

PHN pain can last for months or even years. Those at risk of developing PHN after having shingles include those over 50 years of age and severe pain with the shingles episode.

If you are age 50 or older, you have a more than 50 percent chance of developing PHN. If you are age 80 or older, you have an 80 percent chance of developing PHN.

It is important for the pain of shingles to be treated effectively as this will lessen the chance of PHN.

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Once you have developed PHN, then treatment options include:

* Antidepressants. Your doctor may prescribe a low dose of an antidepressants for postherpetic neuralgia, even if you're not depressed. These drugs affect key brain chemicals, including serotonin and norepinephrine, which play a role in both depression and how your body interprets pain. Use of these drugs often do not eliminate the pain, but can make it more tolerable.

* Certain anticonvulsants. Medications for treatment of seizures also can lessen the pain associated with postherpetic neuralgia. Doctors may prescribe gabapentin (Neurontin), pregabalin (Lyrica) or another anticonvulsant to help control burning and pain.

* Injected steroids. Corticosteroid medications injected into the area around the spinal cord may help relieve the persistent pain of postherpetic neuralgia.

* Painkillers. Your doctor may prescribe painkillers such as tramadol (Ultram) or drugs containing oxycodone, either in short-acting formulations such as Percocet or in long-acting formulations such as OxyContin. These drugs are narcotics and can be addictive.

* Transcutaneous electrical nerve stimulation (TENS). This treatment involves the placement of electrodes over the painful area. The electrodes deliver tiny, painless electrical impulses to nearby nerve pathways. You turn the TENS unit on and off as needed to control pain. Exactly how the impulses relieve pain is uncertain. This treatment doesn't work for everyone.

* Lidocaine skin patches. These are small, bandage-like patches(prescription only) that contain the topical, pain-relieving medication lidocaine. These patches can be cut to fit the affected area. You apply the patches directly to painful skin to deliver temporary relief.

In some cases, treatment of postherpetic neuralgia can bring complete pain relief. Others will get relief, but still experience some pain. Most people can expect the condition to gradually disappear during the first three months. For about 10 percent to 20 percent of people with postherpetic neuralgia, the pain may persist for a year or more.

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National Institute of Health