How Is Nerve Pain Diagnosed
The main way your doctor will diagnose nerve pain is by listening to you and examining you.
In the examination, they will probably test your nerves by testing the strength of your muscles, checking your reflexes, and by seeing how sensitive it is to touch.
You may be asked to have tests like:
- blood tests to check your general health and look for underlying conditions
- nerve conduction studies which measure how quickly your nerves carry electrical signals
- a CT scan or an MRI scan to look for anything that could be pressing on a nerve
How To Treat Nerve Pain Caused By Shingles
This article was medically reviewed by Luba Lee, FNP-BC, MS. Luba Lee, FNP-BC is a board certified Family Nurse Practitioner and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support , Emergency Medicine, Advanced Cardiac Life Support , Team Building, and Critical Care Nursing. She received her Master of Science in Nursing from the University of Tennessee in 2006.There are 31 references cited in this article, which can be found at the bottom of the page.wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 84% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 88,320 times.
Risk Factors For Nerve Pain After Shingles
Researchers have long known that older people are more likely to get PHN, the nerve pain after shingles, but recent studies have found other factors that increase risks.
In one study published in the journal Neurology, researchers — including Dworkin — looked at data from 965 people with shingles. The researchers identified five risk factors for developing PHN in people who had been recently diagnosed with shingles:
- Presence of symptoms before the rash appeared, like numbness, tingling, itching, or pain
- Severe pain during the illness’s initial stages
Importantly, the researchers found the more risk factors you have, the greater the risk of developing PHN.
For instance, 17% of women with shingles and 26% of those who had severe pain went on to get PHN. But 50% of women who were over age 60 and had symptoms before the rash, severe rash, and acute pain went on to get PHN.
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Hearing Loss And Facial Weakness
Complications of herpes zoster oticus and Ramsay Hunt syndrome might include hearing loss and facial weakness. For most people, these are temporary symptoms, but it is possible for the damage to become permanent, especially if shingles is left untreated.
Ramsay Hunt syndrome accounts for up to 12% of facial paralysis. In some cases, it has a worse outcome than Bells palsya condition that causes temporary weakness in the muscles of the face.
Which Antiviral Medication Is Best For Shingles
The antiviral medications used to treat shingles are , , and . They are all effective at helping shingles rashes crust over and heal, and they help reduce pain as you are healing.
In head-to-head studies, a 7-day course of valacyclovir worked faster than a 7-day course of acyclovir at reducing pain. Famciclovir is equivalent to valacyclovir for healing shingles rashes and reducing pain from them. Acyclovir needs to be taken 5 times a day, while Famciclovir and valacyclovir both need to be taken 3 times a day.
Its worth noting that these antiviral medications dont prevent postherpetic neuralgia, which can happen to some people with shingles. And antiviral ointments like Zovirax will do nothing for the rash from shingles.
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When Shingles Pain Doesnt Stop: Coping With Postherpetic Neuralgia
Shingles, also known as herpes zoster, will affect about 1 in 3 Americans during their lifetime. For most, the itching and painful rash will run their course over two to four weeks, and that will be the end of it.
Unfortunately, about 10-13 percent of people who develop shingles will continue to have pain after the other symptoms are gone.
This pain, called postherpetic neuralgia, or PHN, usually lasts only a few weeks or months. But for some people, the pain can persist for years. PHN can afflict anyone whos had shingles, but the risk of developing it increases with age.
If youre one of the unfortunate PHN sufferers, your doctor may recommend one of several treatment options:
The best answer, of course, is to never contract shingles and never develop PHN in the first place.
Shingles is caused by the virus that causes chickenpox, and anyone whos had chickenpox can get it, although its more common in older adults. The virus lies dormant in the body and can resurface years after you recover from chickenpox.
Fortunately, vaccines are available that can prevent or lessen the severity of shingles. If youre over 50 and had chickenpox as a child, talk to your doctor about getting the vaccine.
The information contained in this article is for educational purposes only and is not intended to replace or counter a physicians advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
When Should I See My Doctor
See your doctor as soon as possible if you are experiencing any symptoms of shingles. Starting treatment with antiviral medicines within 3 days of the rash appearing should reduce the severity of symptoms and the risk of further complications, including post-herpetic neuralgia.
See your doctor straight away if you have symptoms of shingles and are experiencing the following:
- symptoms that affect your eye area
- a temperature of 38°C or higher
You should also see your doctor if you are pregnant, or have a weakened immune system due to medicine that suppresses the immune system, or a condition that weakens your immune system.
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How Long Does Nerve Pain Last After Shingles
Only approximately 9-15% of patients who get shingles develop Postherpetic Neuralgia. For those few patients who develop PHN, the length of time that it lasts usually varies. The majority of PHN patients have discomfort that lasts one to two months. About one-third of Postherpetic Neuralgia patients have symptoms that last around three months, and about one-fifth have symptoms that last a year or longer. Researchers are unsure what triggers the herpes zoster virus to re-emerge even after years of lying dormant. The virus may be obtained during youth, but it does not flare into shingles until years down the line. When the pain of shingles lingers long after the rash heals, it is considered Postherpetic Neuralgia. The bout of shingles damages the nerves. This means that the nerve damage caused by shingles affects a fully functioning nervous system. The damaged nerve will send random pain signals to the brain, which thereby causes a burning, throbbing sensation. Over time, the nerves of the skin calm, but due to the existing nerve damage, the pain can persist for years, even for the rest of the persons lifetime.
Oral Care With Shingles
If you have developed new or have healing shingles blisters in the mouth, maintain proper oral hygiene so the ruptured blisters dont get infected. Be careful not to irritate the blisters with your toothbrush, which may slow healing and make them more painful. However, keep brushing your teeth and flossing daily. Your dentist may recommend an antibacterial mouthwash to keep your mouth clean to promote healing.
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How Is Shingles Treated
Specific treatment for shingles will be determined by your healthcare provider based on:
- Your age, overall health, and medical history
- How long the shingles have been present
- Extent of the condition
- Your tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:
- Creams or lotions to help relieve itching
- Cool compresses applied to affected skin areas
- Antiviral medicines
- Anticonvulsants
How Well Does Shingrix Work
Two doses of Shingrix provide strong protection against shingles and postherpetic neuralgia , the most common complication of shingles.
- In adults 50 to 69 years old with healthy immune systems, Shingrix was 97% effective in preventing shingles in adults 70 years and older, Shingrix was 91% effective.
- In adults 50 years and older, Shingrix was 91% effective in preventing PHN in adults 70 years and older, Shingrix was 89% effective.
- In adults with weakened immune systems, Shingrix was between 68% and 91% effective in preventing shingles, depending on their underlying immunocompromising condition.
In people 70 years and older who had healthy immune systems, Shingrix immunity remained high throughout 7 years following vaccination.
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Who Gets Postherpetic Neuralgia
About 1 out of 5 people who have shingles will have these sharp, ongoing pains afterward. Certain things can increase your chances of getting it:
- Age: Most people who get postherpetic neuralgia are older than 60.
- Gender: Women seem to get it more than men.
- Early symptoms: People who have numbness, tingling, or itching before a shingles rash even appears tend to get the lingering pain later.
- Pain at the start: If you had severe pain or a rash during the beginning of your outbreak, you have a greater chance of the neuralgia later.
- Other health problems: People with ongoing conditions that can weaken the immune system, like HIV and cancer, seem more likely to get it.
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Topicals Are Not A Substitute For Medical Treatment
Topical products can help you manage your symptoms. But they arent a substitute for proper medical treatment.
Its important to visit your doctor if youre dealing with shingles. Your doctor can prescribe antiviral drugs and other medications that can shorten the duration of your infection and help you avoid severe complications.
The following creams may be able to help you manage shingles symptoms.
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What Can I Take To Feel Better
Your doctor has a host of ways to treat your pain after shingles, including a variety of medications. They include:
Anticonvulsants: These medications were developed to control seizures, but they can also help reduce the pain of postherpetic neuralgia. Examples are:
Talk to your doctor or pharmacist about side effects of any new prescription or over-the-counter medication.
Treating The Pain Of Phn
Exactly how best to deal with the pain is a difficult question. Rice led a research team that looked at 35 clinical trials of various treatments. The findings appear in the July issue of the free-access online journal PloS Medicine.
“The most important thing to realize is these are painkillers,” Rice says. “You are treating the pain, not the disease itself. And this is due to permanent nerve damage. It is like a stroke. We can’t make the nerve damage better, but we can treat the disability. And for PHN, pain is one of those disabilities.”
What helps? Rice’s team found good evidence supporting:
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When Should I See A Doctor Because Of The Side Effects I Experience From Shingrix
Shingrix causes a strong response in your immune system, so it may produce short-term side effects. These side effects can be uncomfortable, but they are expected and usually go away on their own in 2 or 3 days. You may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen. Contact your healthcare provider if the symptoms are not improving or if they are getting worse.
In clinical trials, Shingrix was not associated with serious adverse events. In fact, serious side effects from vaccines are extremely rare. For example, for every 1 million doses of a vaccine given, only one or two people might have a severe allergic reaction. Signs of an allergic reaction happen within minutes or hours after vaccination and include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness. If you experience these or any other life-threatening symptoms, see a doctor right away.
Are There Alternative Treatments
Some studies show that various alternative treatments, from acupuncture to supplements, can offer relief. The research isnât complete, but some shows promise. Check with your doctor before you try any of these:
TENS . This therapy uses tiny electrical pulses to relieve pain. A TENS unit is about the size of a smartphone and comes with small patches called electrodes. You put them over the painful area and turn the unit on and off as your pain comes and goes.
Traditional Chinese medicine: These treatments aim to restore balance in your body. They include acupuncture, the ancient practice of inserting very thin needles into your skin at specific points. Also, moxibustion and cupping, two types of heat therapy, are supposed to draw out toxins. These treatments may be done in combination.
Creams and other skin treatments: A mixture of liquid dimethyl sulfoxide and idoxuridine, an antiviral drug, may reduce swelling and the number of blisters you have when you put it on your rash. And chlorophyll, the chemical that gives plants their green color, is also used directly on the rash as a cream or saline solution.
Supplements: Youâll find a long list of herbs, pills, and oils that claim to relieve shingles. Most have no research to back them up, but there are a couple of exceptions. Papain, a protein found in papayas, is sold in capsules. And manuka and clover honeys can be put directly on your skin. Very early studies on both show they may be helpful.
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What Causes Nerve Pain
While we still dont know all the causes of nerve pain, we do know that nerves are most often damaged by disease, injury, or the use of drugs, such as chemotherapy. According to the Foundation of Peripheral Neuropathy, 60 percent of people are afflicted with the condition as the result of diabetes, 23 percent from unknown causes, and 10 percent from chemotherapy. The remaining cases could stem from one of these culprits:
- Autoimmune diseases
- Vitamin deficiencies, especially B12 or B1
Go With Gabapentin For Phn
If you do have the lasting nerve pain of PHN, some doctors will prescribe anti-seizure medications, including Neurontin or Lyrica . Even though they were developed as anti-seizure medicines, they can help modulate the nerve pain until the nerves can heal, Dr. Auwaerter explains. These treatments can reduce pain signaling from the nerves to the brain by calming your neurotransmitters for a short time. They are FDA-approved as an effective treatment for PHN. Like antivirals, they require frequent daily dosing, usually three times per day.
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What Does Postherpetic Neuralgia Feel Like
You usually have pain on one side of your body, where you had the blisters. The feeling is described as shooting, sharp, or stabbing. Other signs you have neuralgia include:
- It hurts to be touched: Sometimes, you canât bear clothing rubbing on your skin. You might feel discomfort from a light breeze.
- Long-lasting pain: This condition can last 3 months or longer after the shingles rash has healed. In some people, itâs permanent. For most, it gets better over time.
- Other sensations: Sometimes, you might feel burning, itching, tingling, or aching along with the shooting feelings. Some people feel numb or get headaches.
- You may also get a fever and generally feel worn-out.
Are There Other Ways To Ease The Pain
Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include:
TENS : You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.
Cold packs: Try a gel-filled one to numb the area unless cooler objects make your neuralgia worse.
Comfortable clothes: Go for looser fits and fabrics such as cotton and silk.
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What You Can Do About Nerve Pain That Lingers After Shingles
Chronic pain that continues after a case of shingles is called postherpetic neuralgia . It is estimated that about 20% of patients will experience this type of nerve pain as a complication of shingles.
Those who have had chickenpox are at risk of developing shingles later in life. People who develop PHN are generally age 60 and older. Although there is no cure for PHN, there are several methods of pain management that can ease symptoms. Fortunately, the type of pain that arises from postherpetic neuralgia improves over time.
Neuralgia affects the nerves, causing structural and functional damage. It can feel like a stabbing or burning pain that radiates along the affected nerve.
Neuropathic pain is not caused by an external injury or stimuli but originates from inside the nervous system. When the herpes-varicella zoster virus is reactivated in the form of shingles, scar tissue forms alongside nerves, creating pressure, and sending pain signals to the brain.
Lidocaine Cream And Patches
2017 study suggests that its one of the best-tolerated treatments for PHN.
PHN is a complication of shingles characterized by long-term nerve pain after your rash disappears. The CDC says that about 10 to 18 percent of people experience PHN after shingles.
Lidocaine is often administered in patches. The study linked above notes that up to 3 patches can be applied in a 12-hour window.
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