How Common Is Postherpetic Neuralgia
Varicella-zoster virus causes both chickenpox and shingles. About 99% of Americans over age 40 have had chickenpox. About one in three people in the U.S. develop shingles in their lifetime. Some 10 to 18% of people who get shingles will develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles.
Pain Management For Postherpetic Neuralgia
Postherpetic neuralgia is a complication of shingles, which is caused by the chickenpox virus. The condition affects nerve fibers and skin, causing a burning pain that lasts long after the rash and blisters of shingles disappear. There is no known cure for postherpetic neuralgia, but the pain management experts at Novus Spine & Pain in Lakeland, Florida can help you manage the pain.
A Word About The Shingles Vaccine
If you are age 60 or over and have not had shingles, talk to your doctor about getting the shingles vaccine. Not only will it reduce your risk of developing shingles, but if you do develop shingles, youll be more likely to have a mild case. And, just as important, youll be much less likely to develop PHN if youve had the vaccine.
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Ketamine Infusion For Nerve Pain
Traditional treatment plans for nerve pain, resulting from PHN, include surgery, physical therapy, nerve blocks, and prescription medications, such as antidepressants, anti-seizure medications, narcotic pain medications, and topical medications, among other strategies for pain control. A significant portion of patients diagnosed with PHN, however, may not find relief through these methods or they may not be able to take certain medications due to other pre-existing conditions.
For patients seeking to heal their pain using postherpetic neuralgia natural treatment methods, we recommend ketamine treatment. Ketamine is used extensively to treat therapy-resistant forms of chronic pain conditions, especially in syndromes containing neuropathic components, such as complex regional pain syndrome type 1, or CRPS-1, as well as neuropathic pain and postherpetic neuralgia due to peripheral nerve damage.
During infusions for neuropathic pain treatment, ketamine binds to and inhibits N-methyl-D-aspartate receptors, blocking their ability to communicate with other brain regions and allowing the brain to restore crucial connections previously harmed from shingles and PHN. Ketamine infusions can be combined with other medications to create a balanced approach that accommodates each patients unique brain and body chemistry.
How Long Does Postherpetic Neuralgia Last
Postherpetic neuralgia can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.
The pain from PHN can be so severe in some people that it disrupts their life. Researchers dont know why some people have severe or long-lasting pain and others do not.
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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.
Consider The Benefits Of Capsaicin
Another topical treatment is made from chili peppers, and research has shown that it can help with shingles pain reduction. Capsaicin comes in OTC and prescription forms, and it can be applied topically as a cream or by wearing a patchbut its tricky to administer properly. A report in Molecules noted that capsaicin can cause a burning sensation on the applied area, especially if applied in frequent dosages. In rare cases, it can also cause blood vessel constrictions. Be sure to get your doctors guidance before trying this method on your own.
Spinal Cord Or Peripheral Nerve Stimulation
These are often used to treat several different types of neuropathic pain. Electrodes are placed underneath the skin along the affected peripheral nerves. Before using this technique, doctors will do a test using a wire electrode to get a sense of how the patient will respond.
After the electrodes have been placed above the peripheral nerve, a weak electrical current is sent to the nerve. By stimulating a sensory pathway that doesnt cause pain, experts believe that this electrical signal to the brain can trick the brain into turning off the painful signal, bringing relief to the patient.
Shingles And Your Eyes
If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.
Shingles painand other symptoms from an outbreak of herpes zosterusually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, its called postherpetic neuralgia .
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New Drug For Lingering Shingles Pain
FDA Approves Qutenza for Postherpetic Neuralgia
The new PHN drug is Qutenza. It’s made by Lohmann Therapie-Systems AD of Andernach, Germany, and distributed by NeurogesX Inc. of San Mateo, Calif.
PHN is excruciating, and is often described as a burning, stabbing, or gnawing pain. It starts with an attack of shingles, in which the herpes zoster virus — the chickenpox virus, lying dormant at nerve roots — reactivates.
PHN is pain that persists after the shingles scales heal. It affects 10% to 15% of people who have shingles. It may get better over time. It may not. Treatments include prescription pain medications, anticonvulsants, and antidepressants.
Now there’s Qutenza, a radically different approach. The active ingredient in Qutenza is synthetic capsaicin, the chemical that makes chili peppers burn. There are over-the-counter capsaicin products, but the FDA notes in a news release that “Qutenza is the first pure, concentrated, synthetic capasaicin-containing prescription drug to undergo FDA review.”
“The product can provide effective pain relief for patients who suffer from PHN,” Bob Rappaport, MD, FDA director of Anesthesia, Analgesia, and Rheumatology Products, said in a news release.
Patients may receive an opioid pain drug before or after treatment.
What Outcome Can I Expect If I Have Postherpetic Pain
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.
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When To Seek Medical Advice
See a doctor at the first sign of shingles. Treating shingles earlywithin three days of developing the rashwith oral antiviral drugs may actually prevent PHN. If you do develop PHN, see your doctor right away. Finding an effective treatment to relieve the pain can sometimes be frustrating. You may have to work with your doctor and sometimes other specialists to try a variety of treatments before you find something that helps.
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Can Shingles And Postherpetic Neuralgia Be Prevented
Shingles can only be prevented if you never have chickenpox, or if you have very good immunity against the chickenpox virus . Most people in the UK have chickenpox as a child. However, immunity to the chickenpox virus reduces as you become older.
There is a vaccine against the varicella-zoster virus which is now offered routinely to people in the UK aged 70-79 years. The efficacy of the vaccine declines with age and so it is not recommended for people aged 80 years or older. This vaccine is the most effective way of preventing the development of PHN. It is a very effective and safe vaccine.
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:
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If You Have Shingles Symptoms Get Treatment Now And You May Avoid Permanent Nerve Pain
Shingles, a viral infection of the nerve roots, affects 1 million people in the U.S each year. Most people recover from their bout, but for as many as 50% of those over age 60 who have not been treated, the pain doesn’t go away. It can last for months, years, or even the rest of their lives.
These people have what’s called postherpetic neuralgia , the result of the shingles virus damaging the nerves of the skin. In some cases, the pain is mild. In others, even the slightest touch — from clothing or even a breeze — can be excruciating.
“PHN causes a great deal of suffering and high social costs,” says Robert H. Dworkin, PhD, a professor in the department of anesthesiology at the University of Rochester Medical Center in Rochester, N.Y. “It can severely disrupt people’s lives.”
But the good news is that there are drugs that can help treat and even prevent PHN, and doctors are learning more about who is at greatest risk of developing this debilitating condition.
Soak In A Colloidal Oatmeal Bath
This DYI option hasnt been tested for shingles specifically but experts say it may provide some skin relief while your rash is still acting up. Colloidal oatmeal is made by grinding oats into a fine powder . A study in the Journal of Drugs in Dermatology found that this natural remedy has antioxidant and anti-inflammatory properties which can make it helpful in treating irritated skin. Add colloidal oatmeal to a bath of cool or lukewarm water and soak for about 10 minutes, once per day, for as long as your rash lasts.
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Why Does The Pain Persist In Some People
The symptoms of PHN can last for several months in some people. Shingles causes inflammation of the nerve. Pain can be expected whilst the rash and inflammation occur. However, it is not clear why some people continue to have pain when the inflammation has gone. It is thought that some scar tissue next to the nerve, or in the nearby part of the spinal cord, may be a factor. This may cause pain messages to be sent to the brain.
Shingles And Postherpetic Neuralgia: What Are The Risk Factors
You can’t control whether you’ll catch the chickenpox virus. Fully 99.5% of adults in the U.S. carry it, whether or not they remember having had chickenpox. But why do one-third of those people get shingles — and some of them go on to develop postherpetic neuralgia?
The risk of postherpetic neuralgia also goes up with age. More than 80% of cases of postherpetic neuralgia occur in people over 50 years old. “It’s likely that the natural decline of immunity with age is responsible,” says Ralph.
The results of one study showed that age had a huge effect on the risk for postherpetic neuralgia after shingles:
- Among people under 60 years old who had shingles, less than one in 50 developed postherpetic neuralgia.
- In people aged 60 to 69, about 7% of shingles sufferers developed postherpetic neuralgia.
- In those age 70 and older, almost 20% developed postherpetic neuralgia after a bout of shingles.
Race seems to matter, too. For unknown reasons, white Americans get shingles and postherpetic neuralgia at more than twice the rate of African-Americans in their age group.
“People whose immune systems are impaired by drugs or diseases like AIDS are also more prone to zoster and PHN,” adds Ralph.
Exposure to someone with chickenpox or shingles does not increase your personal risk, however. In fact, experts believe that the slight immune stimulation may boost natural defenses, making you less likely to develop shingles or PHN.
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Preventing Nerve Pain After Shingles
But if you’re worried about PHN, don’t despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: famciclovir , valacyclovir , and acyclovir . These medications need to be started within two to three days of the onset of shingles.
“If you look at the clinical trials with any of these drugs in people over 50,” says Dworkin, “they cut the rate of pain at six months in half. That’s a very significant improvement.” They are also very safe and have few side effects, he says.
But who needs the drugs? Dworkin says there’s not a clear consensus yet.
There are some obvious cases. “I think everyone would agree that someone who is over 50 and has severe symptoms should get preventative treatment,” he tells WebMD.
But for younger people or those with fewer risk factors, the course is less clear.
“Some people think that everyone who gets shingles should get preventative treatment with antiviral medicines, because the medicines are so safe and have such few side effects,” he says.
Others argue that preventative treatment should only be given to those at greater risk. The main reason for this, Dworkin says, is cost.
“A full course of treatment could cost anywhere between $100 and $160,” he says. “That can add up, and insurance companies might not want to pay if the risks are very, very low.”
Shingles Symptoms: What Should You Look For
Unlike the whole-body rash of chickenpox, the shingles rash is limited to the area of skin assigned to the infected nerve. The rash usually consists of small bumps that may turn into blisters before bursting and crusting over. If shingles appears on the face, the eye can be affected, posing a threat to sight.
Also unlike chickenpox, this rash hurts, sometimes intensely. People typically describe shingles pain as burning, stabbing, or electrical.
“Shingles can be almost unbearably painful,” says Jeffrey Ralph, MD, assistant professor of neurology at the University of California in San Francisco and a fellow of the Neuropathy Association. “The nerve itself is inflamed. The pain can sometimes come even weeks before a rash appears.”
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Are There Treatments I Can Put On My Skin
You might find relief with topical treatments. You can talk to your doctor about:
Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin and Zostrix. You can buy this over the counter but make sure your doctor knows if you plan on using these.
Patches: Capsaicin is also in Qutenza, which is applied via a patch for one hour every 3 months. You need to visit the doctorâs office for this.