What Causes Postherpetic Neuralgia
Postherpetic neuralgia results from damage to nerve fibers during shingles infection. The nerve fibers at the skin in the affected area send exaggerated pain signals to your brain. Postherpetic neuralgia means nerve pain after herpes. Shingles is also called herpes zoster.
Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once youve had chickenpox, the virus remains in your body for your entire life, but is dormant or silent for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people who get shingles develop PHN.
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
What Are The Risk Factors For Internal Shingles
Many of the risk factors for internal shingles are the same as those for the skin rash of shingles. They include:
- Having a weakened immune system. Diseases and conditions such as HIV/AIDS, organ transplant, and autoimmune conditions like lupus, rheumatoid arthritis, or inflammatory bowel disease can make you more susceptible to shingles.
- Undergoing cancer treatment. Cancer, along with radiation and chemotherapy, also weaken your immune system and can increase your risk of a herpes zoster infection.
- Being older than 60. Shingles can occur in people of any age. However, its more common in older adults. About half the cases of shingles develop in people over 60 .
- Taking certain medications. Drugs that lower your chance of rejecting an organ transplant or treat autoimmune diseases will increase your risk of shingles. Examples include cyclosporine and tacrolimus . Extended use of steroids will also increase your risk. These medications suppress your immune system, making your body more vulnerable to infection.
Not receiving the shingles vaccine will also increase your chances of getting the condition. Even if you dont remember ever having chickenpox, you should get the shingles vaccine. Studies have shown that 99 percent of people over 40 have had chickenpox. According to the
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How Is Shingles Prevented
In New Zealand, shingles vaccine is available for people over the age of 50. It reduces the risk of getting shingles and its complications you may still get shingles but the symptoms are usually less severe and post-herpetic neuralgia is less likely.
- In New Zealand, one dose of the shingles vaccine is funded for people aged 65 years, or for people aged between 66 and 80 years inclusive from 1 April 2018 and 31 December 2021.
- Some people aged under 65 years who are at increased risk of shingles may also want to think about having the vaccination, although it is not funded for this group. You are at increased risk of shingles if you have a weakened immune system, rheumatoid arthritis, COPD, asthma and diabetes. Read more about shingles vaccine.
What Can I Do For The Pain
To help with the pain of shingles, your doctor might have you take an over-the-counter pain medicine. This could include acetaminophen or ibuprofen .
Applying a medicated anti-itch lotion to the blisters might reduce the pain and itching. Placing cool compresses soaked in water mixed with white vinegar on the blisters and sores might also help.
If shingles causes severe pain, your doctor might prescribe a stronger pain medicine.
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Is The Condition Curable
There is no cure for shingles, but attacks can be rendered less severe and their duration shortened with the use of prescription antiviral drugs.
Several antiviral medicinesacyclovir, valacyclovir, and famciclovirare available to treat shingles and shorten the length and severity of the illness. These medicines are most effective if you start taking them as soon as possible after the rash appears. If you think you have shingles, contact your healthcare provider as soon as possible to discuss treatment.
Pain medicine, either over-the-counter or a prescription from your doctor, may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths can also help relieve itching.
Vaccine Prevention For Shingles And Postherpetic Neuralgia
In 2006, a vaccine to prevent shingles came onto the market. Called Zostavax, the vaccine cuts the likelihood of getting shingles after chickenpox by about half, dramatically reducing the number of people who might get nerve pain after shingles.
Based on these results, the CDC recommends Zostavax to all adults age 60 and older. Rumbaugh goes further: He suggests you get vaccinated at any age if you have had shingles. His clinical experience suggests the vaccine helps reduce postherpetic neuralgia even after infection with the varicella zoster virus.
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Understanding Chronic Shingles Pain
If you had chickenpox as a child, you may be at risk of developing shingles as an adult, as both conditions are produced by the same virus: varicella-zoster. Even after the condition has improved and symptoms have disappeared, people never truly recover from the disease. The virus lies dormant in the body and has the potential to resurface later in life. Research suggests that the virus comes back as an individual gets older and their immune system becomes weaker. The pain management specialists at Southwest Spine and Pain Center are able to help patients understand what shingles pain is and how to prevent it from becoming chronic.
Understanding Shingles Pain
Shingles typically begins with pain and other symptoms such as sensitivity to touch, numbness, or tingling. After a few days, the condition progresses into a painful, blistering rash. Shingles patients may also experience fevers, headaches, and body aches. Depending on the location of the pain, patients may mistake their symptoms with heart, lung, or kidney problems. Nevertheless, some people with shingles never develop a rash, or really intense, sharp pains. Some shingles patients have reported pain flare-ups from certain triggers like brushing skin across furniture or from the wind hitting their bodies.
Avoiding Chronic Pain
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.
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Shingles Linked To Stroke Heart Attack
Not only do shingles flare-ups hurt, research says they can increase your short-term risk of heart attack and stroke following the virus outbreak.
Shingles was found to raise the risk of stroke by 35% and the risk of heart attack by nearly 60%, according to a study of more than half a million people. The risk of stroke was highest in those under age 40.
Its been known for a while now that zoster causes stroke, said Dr. Gwen Wigand-Bolling, an internist at . The inflammation it creates causes heart attack and stroke, and shingles causes increased blood clotting in the arteries, she added.
The risks of both stroke and heart attack were highest in the first year after the onset of shingles and decreases with time, researchers said.
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 Can This Pain Be Managed
If your doctor is able to identify an underlying cause for the neuropathic pain, treating it may reduce and even eliminate the pain.
For example, diabetes is a common cause of neuropathic pain. Proper diabetes care which includes a healthy diet and regular exercise may eliminate or reduce neuropathic pain.
Taking care of blood sugar levels can also prevent worsening pain and numbness.
Shingles Symptoms Before Rash
Shingles develops in two stages. The first is called the prodromal period.
Shingles is a reactivation of the varicella virus, which is what causes chickenpox. After an initial infection, the virus lays dormant in the body. Once reactivated, which can happen years down the line, shingles results.
Often, the earliest signs this is occurring are similar to what you’d expect at the start of any infection. These symptoms sometimes occur at times when you’re feeling stressed or run down. They are also systemic, meaning they affect the whole body.
You may assume you’re just overtired or coming down with a cold when you actually have shingles.
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Rebooting The Nervous System
Its like restarting a computer, Dr. Rosenquist says. When its running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully, it will send an appropriate transmission as opposed to a pain transmission.
Treatmentoptions for PHN patients include:
Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.
How Long Does Shingles Last
Most cases of shingles last three to five weeks.
- The first sign is often burning or tingling pain sometimes it includes numbness or itching on one side of the body.
- Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
- A few days later, the rash will turn into fluid-filled blisters.
- About one week to 10 days after that, the blisters dry up and crust over.
- A couple of weeks later, the scabs clear up.
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How Do Dermatologists Diagnose Shingles
A dermatologist can often diagnose shingles by looking at the rash on your skin.
If there is any question about whether you have shingles, your dermatologist will scrape a bit of fluid from a blister. This will be sent to a lab where a doctor will look at the fluid under a high-powered microscope.
When you have shingles, the fluid contains the virus that causes shingles. Seeing the virus confirms that you have shingles.
Your dermatologist will also ask about your symptoms. Shingles tends to be painful.
When the shingles rash spreads to an eye, it can affect your eyesight
You can reduce this risk by seeing an ophthalmologist immediately.
Best Treatments For Lasting Shingles Pain
Postherpetic Neuralgia Pain: What Works, What Doesnt
Doctors call it postherpetic neuralgia or PHN. Its caused by nerve damage left behind by a case of shingles. Shingles itself comes from reactivation of a chickenpox virus, varicella zoster. The virus travels down nerve fibers to cause a painful skin rash.
When the rash goes away, the pain usually goes with it. But for 12% to 15% of people the pain remains. If your shingles pain lasts eight to 12 weeks after the rash goes away, youre part of an unfortunate minority, says pain researcher Andrew S.C. Rice, MD, of Imperial College, London.
Among people with PHN, some have their pain resolve in the first year to 18 months after the shingles rash goes away, Rice tells WebMD. But if they have pain longer than that, it is not going to go away on its own. In either case, a person must deal with the pain.
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What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.
New Drug Treatment Reduces Chronic Pain Following Shingles
by Sam Wong05 February 2014
A new drug treatment has been found to be effective against chronic pain in patients who have had shingles.
The researchers hope that the drug might also be effective against other causes of pain caused by nerve damage, known as neuropathic pain, such as diabetes, HIV, nerve injury and cancer chemotherapy, as it targets a mechanism that is not targeted by any existing therapies and has fewer side effects.
Drugs available now have limited success at treating neuropathic pain and often have unpleasant or disabling side effects.
It is estimated that around 190,000 people in the UK get shingles every year, most of them aged over 50. It is caused when a dormant viral infection of a nerve is reactivated, resulting in a painful rash. In most cases, the shingles rash lasts a few weeks, but in some cases the permanent nerve damage caused by the virus results in a chronic neuropathic pain called post-herpetic neuralgia. Around one in 10 people with shingles experiences post-herpetic neuralgia and, once established, it usually causes life-long suffering.
In a study involving 183 patients with post-herpetic neuralgia in six countries, the new drug EMA401 was found to reduce pain and did not cause any serious side effects. The findings are published in The Lancet.
Spinifex Pharmaceuticals, which owns the drug, now plans to conduct a larger trial, possibly testing higher doses of the drug for longer periods of time.
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What Causes Internal Shingles
The varicella zoster virus causes shingles. Its the same virus that causes chickenpox. After a bout of chickenpox, the virus becomes dormant in the body and settles in certain nerves and tissue of the nervous system. Later in life, the virus can reactivate and present itself as shingles. Shingles typically appears on the skin along the nerve path where it had been previously dormant. If the reactivation of the virus becomes severe, it can affect not only the skin but other organs too. This is what is called systemic or internal shingles.
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.
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Focus On Prevention Doctors Say
Prevention is the best way to avoid a shingles episode.
There is a vaccine that prevents the onset of shingles in people exposed to chickenpox. The CDC recommends that people age 60 and older get one dose of the vaccine. Vaccines are readily available at a doctors office and drug stores. In 2011, the Food and Drug Administration extended the vaccine use for people aged 50 to 59.
Wigand-Bolling said the vaccine reduces the incidence of shingles by 51% and the neuralgia associated with shingles by 67%. The doctor said the vaccine is injected and once vaccinated a person is protected for life.
Unless contraindicated because of pregnancy or being an organ transplant recipient or on chemotherapy, everyone over age 50 should be vaccinated, Wigand-Bolling said. I would recommend getting vaccinated to patients who may not have had chicken pox, or those who dont remember having chicken pox.
More than 90% of those identified in the study at increased risk of stroke and heart attack after a shingles episode hadn’t been vaccinated for shingles. The people in the study who had the vaccine still got shingles, it’s worth noting.