Tuesday, April 9, 2024

Post Herpetic Neuralgia From Shingles

What Outcome Can I Expect If I Have Postherpetic Pain

Shingles, zoster, and post-herpetic neuralgia

Theres no standard treatment for the symptoms of postherpetic pain . Depending on the severity of your pain, you may start with over-the-counter products. If your pain is more severe, one or more prescription medications may be tried. PHN is difficult to treat. Achieving a complete symptom-free state was achieved in less than half the patients with PHN, according to one study.

PHN tends to happen in older individuals who may have other health conditions, which can complicate treatment and results. Pain can last weeks, months and even longer than a year. In some people, the pain can be debilitating. In most people, PHN lessens with time.

A note from Cleveland ClinicThe best way to not get postherpetic neuralgia is to prevent it from happening in the first place. Varicella-zoster virus causes both chickenpox and shingles. Vaccines are available to protect against developing both of these viral infections.

Once you develop chickenpox, the varicella-zoster virus remains in your body for life. If the virus reactivates and causes shingles, you have a few days around the rash outbreak to see your provider and get an antiviral medication, which can significantly lessen your symptoms. Still, if you develop PHN, your provider has many medications available to manage your symptoms.

Who Should Get The Shingrix Vaccine

The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if:

  • Youve had shingles.
  • Youre not sure if youd had chickenpox .
  • Youve already had the Zostavax vaccine. This vaccine for shingles is no longer available in the U.S. Ask your healthcare provider about the best time to get the Shingrix vaccine.

If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.

Can I Prevent It

The FDA has approved two shingles vaccines, Zostavax and Shingrix. A vaccine is now recommended for everyone 60 and older. People from 50 to 59 may want to talk to their doctor about it if they have ongoing pain or skin issues or have a weakened immune system.

The vaccines cut the chance of shingles by at least 50%. Even if you still get shingles, the painful period is shortened and you reduce your risk of postherpetic neuralgia.

Early treatment for shingles can also lower your chances of getting this complication. So if you think you have it, call your doctor right away. The main treatment is with antiviral drugs during the early stages of shingles, within 2 to 3 days of symptoms coming on. Medications used include:

Also Check: How Often Do You Need Shingles Vaccine

How Is Postherpetic Neuralgia Treated

If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir , valacyclovir or famciclovir . These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed.

If your shingles outbreak is not caught early, your healthcare providers has many options to manage your postherpetic neuralgia symptoms.

If your pain is mild, your healthcare provider may recommend:

  • Acetaminophen or NSAIDs such as ibuprofen .
  • Creams and patches include lidocaine and capsaicin .

If your pain is more severe, your healthcare may prescribe:

  • Antiseizure drugs gabapentin and pregabalin .
  • Antidepressants, such as escitalopram , quetiapine or amitriptyline.
  • Botulinum toxin injections in the area where you are having pain.

Theres no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. You and your provider will discuss options and what makes sense to try for you. Contact your provider if your pain is not lessening after taking your medicine. Take all your medications exactly as prescribed.

Cme Questions About Herpes Zoster And Postherpetic Neuralgia

The Pain After Shingles: Post Herpetic Neuralgia
  • Which one of the following statements about herpes zoster is true?
  • Risk decreases with increasing age
  • It presents as a disseminated rash
  • Patients with HZ are infectious for 48 hours before the onset of the rash
  • It usually affects the trunk or face
  • It is associated with pain that is usually self-limited and mild
  • In which one of the following sites should HZ involvement prompt referral to an ophthalmologist?
  • Which one of the following treatments for HZ has been shown to the risk of postherpetic neuralgia ?
  • Anticonvulsants
  • Which one of the following medications presents the least risk for an elderly patient with PHN?
  • Per the recommendations of the Advisory Committee on Immunization Practices, HZ vaccine is indicated for which one of the following patients?
  • A 49-year-old man awaiting kidney transplant
  • A 36-year-old woman with newly diagnosed breast cancer
  • A 61-year-old patient with a 10-year history of type 2 diabetes mellitus
  • A 61-year-old patient taking 40 mg/d of prednisone for temporal arteritis
  • A 22-year-old man with human immunodeficiency virus infection and a CD4 count of 50 cells/mm3 of blood
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    How Is Postherpetic Neuralgia Diagnosed

    Postherpetic neuralgia is usually diagnosed based on your symptoms, history of having shingles and physical exam. If youve had a recent case of shingles and have pain in the area where the shingles rash once was, you likely have PHN. Your provider may want to make sure your pain is not caused by something else, but in most cases, no other tests are needed.

    Shingles & Postherpetic Neuralgia

    It stays dormant for decades, waiting for the right time to reactivate or awaken. When the virus wakes up, it will spread along and within the closest major nerve to its sleeping place causing a painful condition we call shingles. Shingles usually begins with fever and headache, accompanied by itchiness and oversensitivity in a distinct and limited area of your skin. This resolves into a characteristic stripe, or belt like rash in which small blisters form. The pain can be intense and even last for years after the rash disappears, a condition referred to as postherpetic neuralgia . PHN is notoriously difficult to treat, so choosing the right pain management doctor is crucial.

    At the Ainsworth Institute of Pain Management, we are uniquely trained and specialized in treating shingles and PHN. Our board certified pain management specialists can offer a combination of treatment options, many not available anywhere else.

    What causes the varicella zoster virus to reactivate is not fully understood. It is known, however, that shingles are likely to appear when someones immune system is impaired, either by age, disease or psychological stress.

    Recommended Reading: What Age Is Shingles Vaccine Free

    What You Can Do About The Nerve Pain That Lingers After Shingles

    Postherpetic neuralgia is a painful, chronic condition that can occur following shingles, a viral infection that causes a mildly itchy to intensely painful rash.

    PHN occurs most often in elderly people and in people whose immune systems have been compromised.

    The pain of PHN, which occurs in the same area as the pain and rash of shingles, results from damage to nerve fibers during the shingles infection. Shingles is caused by a reactivation of the varicella-zoster virus, the same virus that causes chickenpox. Anyone who has had chickenpox can get shingles, but the disorder is most common in people over age 60.

    Treatment Of Herpes Zoster

    What is Postherpetic Neuralgia?

    The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.

    Also Check: Loose Non Stick Sterile Bandages For Shingles

    Management Of Acute Herpes Zoster

    Herpes zoster is treated with oral guanosine analogues . These medications target VZV by relying on viral kinases for phosphorylation, which promotes incorporation into viral DNA, thus disrupting replication.1 Acyclovir is less expensive but has lower bioavailability and must be taken five times per day. Valacyclovir , a pro-drug of acyclovir, is taken three times per day, as is famciclovir.10 Acyclovir is the only antiviral medication approved for the treatment of herpes zoster in children. Patients with severe disease, especially those with immunocompromise, should be treated with intravenous acyclovir.1 Although treatment of herpes zoster ideally should be started within 72 hours of the appearance of the rash,1,2,7 treatment is still warranted outside the 72-hour window if new skin lesions are developing or if ophthalmic or neurologic complications are present.7

    Acyclovir decreases the time during which new lesions occur by 12 hours and the time to full crusting by two days, while decreasing pain severity.14 Valacyclovir and famciclovir have similar effects.15,16 The use of antiviral medications does not reduce the incidence of postherpetic neuralgia.17

    What Are Typical Symptoms Of Post

    The symptoms of PHN are very often limited or localised to the area of skin where the shingles outbreak first occurred.1 This is why PHN is often referred to as being a type of localised neuropathic pain.3

    The chronic pain associated with PHN can be described as burning pain, stabbing pain, itching or aching. Patients with PHN often have hypersensitive skin, like a bad sunburn, and may feel severe pain from the touch of clothing on the affected area, a condition doctors call allodynia.1,4

    Recommended Reading: Shingles Topical Treatment Over The Counter

    How Is Postherpetic Neuralgia Diagnosed And Treated

    Most of the time, your doctor is able to make a diagnosis of postherpetic neuralgia based on how long youve experienced pain following shingles. Tests are unnecessary in confirming a diagnosis.

    Treatment for postherpetic neuralgia aims to manage and reduce the pain until the condition goes away. Pain therapy may include the following treatments.

    What Is Post Herpetic Neuralgia

    Postherpetic Neuralgia Explained : Shingles virus, Postherpetic ...

    Postherpetic neuralgia is nerve pain caused by damage to your nerves from the herpes zoster, or shingles, virus. Postherpetic means after, or caused by, the herpes zoster virus. Neuralgia means nerve pain.

    What are Shingles?

    Chickenpox is a common childhood disease caused by the varicella zoster virus, which is related to the herpes zoster virus. It causes a rash over the body of itchy red bumps. After getting the disease, the virus doesnt fully go away, but it retreats to nerve tissues near your brain and spinal cord. In the meantime, your body creates immunity against the virus so you wont get chickenpox a second time.

    But sometimes the bodys immune system becomes weaker or wears down over time, and the varicella zoster virus wakes up as herpes zoster. When this happens, it doesnt cause chickenpox again, but instead causes a different syndrome called shingles.

    Shingles, or herpes zoster, is an itchy rash that usually happens just on one side of your body. It causes redness in one area, shooting or stabbing pains, a tingling feeling, and blisters that raise on the skin and then crust over and dry out in about a week.

    Shingles cant be cured, but it can be treated. The quicker you get into the doctor and receive treatment, the less severe your symptoms may be and the faster they can go away.

    Shingles is not contagious, but if you have a shingles rash, you can give chickenpox to someone whos never had it before. The virus is spread by physical contact.

    Also Check: When To Get 2nd Shingles Vaccine

    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.

    Kims Postherpetic Neuralgia Symptoms: No Worse No Better

    Back home, Kims symptoms did not improve much. She was unable to return to work because of the pain, problems with her vision, and the side-effects of the gabapentin, which caused memory problems. By mid-Julymore than 4 months after the initial onsetshe still had swelling in her eye, spots on her cornea, scabbing on her scalp, and a great deal of burning pain. It was like someone had set an iron on my head and left it there, she recalls. She describes her condition at this point as kind of treading waterno worse, no better.

    Kims neuralgia created a lot of pain, but she had other problems as well, particularly with her vision. She was given eye drops, which she had to use every waking hour. These helped some, she says, but being in bright lights was almost unbearable.

    Recommended Reading: What Are Shingles Made Of

    Condition Can Be Prevented With The Shingles Vaccine

    Shingles is a painful condition that can develop many years after a person contracts chickenpox. The virus that causes chickenpox, varicella zoster, quietly remains inactive in the nervous system after a person recovers from chickenpox. In certain patients, the varicella zoster virus becomes active again in later life , causing the pain, rash, and blisters of shingles. People most likely to develop shingles are those with a weak immune system, often from a chronic disease or drug therapy. Common causes of weakened immunity include emotional or physical stress, traumatic injuries, cancer, autoimmune disease, HIV/AIDS, and treatments such as chemotherapy, steroids, and radiation therapy.

    Will The Pain Go Away

    Alternatives for Chronic Pain Management in Postherpetic Neuralgia | The Balancing Act

    Without treatment, PHN typically eases gradually and goes. In about 5 in 10 people with PHN, symptoms are gone by three months. However, without treatment, about 3 in 10 people with PHN still have pain after a year. Some people have a slow improvement over a long period of time. A small number of people do not have any improvement over time without any treatment.

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    What Are The Symptoms Of Postherpetic Neuralgia

    Common postherpetic neuralgia symptoms include:

    • Burning, sharp, jagging or aching pain in the area where the shingles rash appeared.
    • Itchiness or numbness at or near the area of the former rash.
    • Pain that is constant or comes and goes. Pain typically lasts, on average, for three months after the rash has healed, but can last for more than a year or longer.
    • Pain at affected skin area can be brought on even with a light touch .
    • Pain gets worse at night or in heat or cold temperatures.

    Chronic Nerve Pain From Shingles

    Postherpetic neuralgia is a painful nerve condition that lingers after a shingles infection. Nerve pain, or neuralgia, is a common symptom of shingles, but in most cases the pain disappears a few weeks after the rash and blisters clear up. Chronic nerve pain occurs in about 20% of patients who develop shingles in their 60s, and it is even more likely in 70- and 80-year-old patients with shingles. Postherpetic neuralgia pain can continue for months or years as a result of nerve damage caused by the shingles virus. Although there is no cure, there are several medications that can be used to ease PHN pain.

    Read Also: Can You Get Shingles If You Have Had The Vaccine

    Can Postherpetic Neuralgia Be Prevented

    The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. The recombinant herpes-zoster vaccine is recommended to prevent shingles in adults ages 50 and older. The vaccination is given in two doses, two to six months apart. The two-dose vaccine is 90% effective at preventing shingles and PHN. Protection lasts at least for four years after you get vaccinated.

    If you have never had chickenpox or have children who have never had chickenpox, getting the chickenpox vaccine can help prevent getting this infection in the first place. If you never get chickenpox, you will not have the varicella-zoster virus in your body and will not get shingles or PHN.

    How Is It Diagnosed

    TCM News: October 2014

    As PHN is solely the persistence of pain after HZ has cleared up there are usually no visible features to aid in diagnosis however some people will have some scarring and pigmentation from the rash.

    PHN is not diagnosed until 2-3 months after the shingles rash has healed. If similar but refractory pain persists at this point, then the individual has more than likely developed PHN. The rash, and therefore the pain, will most commonly manifest in the torso and can include any of the following feelings of pain at differing degrees:

    • Lancinating pain: this term is used to describe all types of what we experience as sharp pains this includes jabbing, piercing, knife-like, cutting of stabbing
    • Allodynia: an abnormal, unpleasant and painful sensation that can occur in the area where the rash was or in the surrounding area
    • Spontaneous pain and
    • Hyperalgesia: this is the increased sensitivity to pain.

    For some, it may be only one of the above pain while for others it will be a combination . In some cases the pain is avoidable if certain situations that may exacerbate the pain can be steered clear of such as wearing tight-fitting clothing or exposure to sudden and intense changes in temperature. Unfortunately though even very light pressure, such as a gentle breeze or a brush of clothing, can cause some people intense pain, and this is for the most part unavoidable.

    Recommended Reading: What Does The Medical Condition Shingles Look Like

    Enhancing Healthcare Team Outcomes

    Considering that postherpetic neuralgia is difficult to treat and outcomes are variable, prevention is of paramount importance. Therefore, primary care physicians and geriatricians are tasked with administering vaccinations to at-risk populations. When preventative measures fail or are never instituted, experts in the field of pain management who have experience with the condition and multimodal treatment techniques should be consulted. An interprofessional approach to managing patients with postherpetic neuralgia is the best way forward.

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