What Is Postherpetic Neuralgia
Postherpetic neuralgia is a condition of recurring or persistent pain in an area of the body that has undergone an outbreak shingles .
When the shingles virus damages nerve cells of an infected area, it often causes a painful skin rash that appears as a patch or line of painful blisters on the skin in the shape of a band. The band of blisters follows the distribution of the nerve where the virus was present before it spread to the skin.
Postherpetic neuralgia is a painful condition that often begins after shingles lesions begin to crust over and heal, but it may occur when lesions are not produced by the virus.
What Can I Do To Help Prevent Shingles Or A Shingles Outbreak
- A vaccine may be given to help prevent shingles. You can get the vaccine even if you already had shingles. The vaccine comes in 2 forms. A 2-dose vaccine is usually given to adults 50 years or older. A 1-dose vaccine may be given to adults 60 years or older.
- The vaccine can help prevent a future outbreak. If you do get shingles again, the vaccine can keep it from becoming severe. Ask your healthcare provider about other vaccines you may need.
Treatment Of Herpes Zoster
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.
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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.”
Postherpetic Neuralgia Treatment: Soothing The Pain
Once postherpetic neuralgia occurs, antiviral drugs can’t treat the pain because ongoing infection isn’t the problem. Instead, treatment aims to soothe and quiet the misfiring nerves that are creating the pain.
There are a variety of oils and creams available at drugstores. Some turn to herbal oils and creams, such as extracts from geranium, lavender, eucalyptus, tea tree, and bergamot.
Others use capsaicin cream, made from hot chili peppers. A drug called Qutenza contains “pure, concentrated, synthetic capasaicin,” according to the FDA. Qutenza can be used every three months and is applied by a doctor via a patch or patches placed for an hour on the places on the skin that hurt. Before applying the patch, the doctor spreads a topical anesthetic on the area to be treated.
Ralph said many people find relief from the anesthetic lidocaine, available in low-concentration creams or patches over the counter, or by prescription in higher concentration patches.
“The lidocaine soaks through the skin and numbs the painful nerve endings,” says Ralph. Lidocaine patches are particularly helpful for people with allodynia, Ralph adds.
If topical creams and oils don’t provide sufficient relief, Ralph recommends asking your doctor about prescription medicines that may help, including some antidepressants, anti-convulsants, and opioids.
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What Causes Postherpetic Neuralgia
Postherpetic neuralgia begins when the virus that causes chickenpox affects an individual. After having chickenpox, the virus remains in the body forever. The virus can reactivate, usually decades later, and produce shingles lesions. The reactivation of the virus is thought to be due to stress on the body from either another infection or if the patients immune system is compromised that allows the virus to escape the nerve cells.
The nerve fibers damaged from the chickenpox virus are unable to transmit normal sensation messages from the skin to the brain. Instead, the sensation messages become confused and exaggerated, causing chronic, often excruciating, pain that can last months or even years. However, postherpetic neuralgia does not occur in everyone who suffers from shingles.
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.
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Can I Prevent Shingles
Who should get it: The CDC recommends that you get this vaccine if youâre a healthy adult age 50 or older, whether or not you remember having had chickenpox, because most people have been exposed to the virus. If you have had the Zostavax vaccine, you can also have Shingrix.
How many shots do you need? You would need two shots for Shingrix: One at first, with a follow-up in 2 to 6 months.
What it does:Shingrix reduces your chance of getting shingles by more than 90%. Even if you still get shingles, the vaccine may help it be less painful.
I never had chickenpox. Do I still need the shingles vaccine? Yes, you do. Shingrix is recommended for everyone age 50 or older, whether or not you remember having had chickenpox.
If Iâve had shingles, can I still get the vaccine? Yes. It may help prevent you having another bout of shingles later on. If you have shingles right now, you should wait until the rash is gone before you get vaccinated.
Donât get the Shingrix vaccine if you:
- Are allergic to any of the ingredients
- Are pregnant or nursing
- Have tested negative for immunity to the chickenpox virus. Ask your doctor about the chickenpox vaccine instead.
- Have shingles now
Why Shingles Can Be Painful
Before we walk you through treatment options, lets look at why this virus can cause pain. The varicella zoster virus develops a latency after chickenpox in these nerves called dorsal root ganglia, explains Paul Auwaerter, M.D., clinical director of the division of infectious diseases at Johns Hopkins Medicine in Baltimore. What can happen is, for reasons that arent entirely clear, the virus can reactivate within a nerve. The virus then travels along that pathway to the skin, causing a painful rash. In serious cases, it can lead to lasting nerve damage called postherpetic neuralgia, or PHN.
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The Emotional Toll Of Nerve Pain After Shingles
Researchers are not just looking at biological and neurological risk factors for PHN. Dworkin was also a co-author of a study looking at psychological risk factors, too. The results were published in the Journal of Pain in 2005.
“It certainly looks like psychological stress can be a potent risk factor for PHN,” Dworkin tells WebMD.
The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.
Dworkin says previous studies have already shown a connection between stress and shingles development.
“One study even found that the risk of developing PHN was higher in people who were living alone when they developed shingles than people living with others,” Dworkin says, perhaps indicating that social isolation increases the risks of PHN.
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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Coping With Shingles Pain
If you have shingles, you may be wondering how to cope with the pain:
- Be sure to get plenty of sleep and eat a healthy diet to help boost your immune system.
- Wear comfortable, loose clothing with natural fiber .
- Establish or maintain a regular exercise routine.
- Utilize home remedies to help soothe pain from blisters.
- Engage in activities that help take your mind off of the pain.
- Establish a routine to help manage stress.
- Seek out support when needed from family and friends as well as professional supportive services.
Early Intervention Is The Key To Treatment
Antiviral medicines such as valacyclovir , famciclovir or acyclovir , taken orally, are usually used to treat shingles. When taken at the very beginning, Ralph says, they can improve symptoms and reduce the risk of postherpetic neuralgia.
Starting antiviral treatment for shingles more than three days after symptoms start is generally believed to be ineffective because the virus is no longer reproducing. Still, many doctors will try treating the condition with antiviral drugs after this time.
An aggressive, early approach to controlling shingles pain may also reduce a person’s chance of developing PHN. In one study, people who started taking amitriptyline for shingles pain as soon as a rash appeared had less pain after six months than those taking a placebo.
“Rapid initiation of treatment for shingles is very important,” says Rumbaugh. “If treatment is started in the first three days, it can reduce the chance of postherpetic neuralgia and make it less severe if it does occur.” This window of opportunity is often missed, however, because most people don’t get to the doctor that quickly.
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Common Questions About Shingles
What triggers a shingles outbreak? Shingles, also called herpes zoster, is a painful skin rash that can be caused by the varicella zoster virus . The virus is spread through saliva and sweat and can be caused by chickenpox. It can also be caused by reactivation of the VZV infection after a long period of dormancy. There is no cure for shingles, but treatment focuses on relieving pain and providing support to the affected area.
Are your shingles contagious? If youâve ever had shingles, you may be wondering if youâre contagious. Itâs important to know that there is no definitive answer, but itâs possible for shingles to spread from one person to another. There are a few things that can increase your risk of spreading shingles: having close contact with someone who has the virus being pregnant having a weakened immune system and having other chronic medical conditions. If youâre concerned that you may have contracted shingles, itâs important to see your doctor for an evaluation.
How does a person get shingles? A person can get shingles from either chickenpox or herpes simplex virus . The virus attacks the nerve cells in your skin and spinal cord. The pain, inflammation, and blisters that result are called shingles. Although it is rare, a person can also get shingles from a dental procedure or an injury to the skin.
What is the most painful stage of shingles? The most painful stage of shingles is when the rash starts to blister.
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.
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Steroids Can Sometimes Help
Dr. Auwaerter notes that some older research done in the early 2000s supports the use of the steroid prednisone taken with an antiviral for short-term shingles pain relief, as well as a decreased risk of developing the more serious PHN. Steroids may be especially beneficial for people over 50, who are at higher risk for PHN. However, they can increase your risk of immunosuppression over time, so theyre generally used for shingles for just one to two weeks. If youre trying this approach, work closely with your doctor to manage the appropriate dosing.
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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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.
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
Am I A Good Candidate For Nerve Blocks
People whoâve had pain for several months and havenât responded to traditional therapies are usually good candidates for nerve blocks.
Nevertheless, you should inform your doctor if you are allergic to any medication if you are pregnant, have an active infection, have diabetes or heart disease, or if you are taking blood-thinning medication.
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When To See A Doctor
Chronic intercostal neuralgia can greatly impact a persons quality of life.
The condition can be extremely uncomfortable. Chronic pain from intercostal neuralgia can also lead to reduced movement and poor sleep quality. It can also make it difficult for a person to breathe.
Also, intercostal neuralgia has some symptoms in common with other potentially serious health conditions. These include:
For this reason, it is important for anyone with prolonged or acute intercostal neuralgia to see a doctor immediately.
People should also see a doctor if they experience other symptoms of shingles.
Can You Prevent Postherpetic Neuralgia
It is possible to prevent postherpetic neuralgia by taking medication at the first symptoms of a shingles infection. Doctors treat shingles with antiviral medications like acyclovir. Starting them within 72 hours of the rash outbreak may give the best results. These drugs can shorten the course of disease and reduce the chance of postherpetic neuralgia.
Preventing shingles also prevents postherpetic neuralgia. The recombinant zoster vaccine, known as Shingrix, is an effective vaccine for people ages 50 and older to prevent shingles.
This vaccine is 97% effective at preventing shingles in adults ages 5069 years who do not have weakened immune systems, and 91% effective at preventing postherpetic neuralgia in adults 50 and older.
The CDC also recommends Shingrix for people 19 and older with reduced immune system function. The shingles vaccine is appropriate even if you had shingles or received the chickenpox vaccine.
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