Post Herpetic Neuralgia

Postherpetic neuralgia [pohst-her-PET-ik noo-RAL-juh] is a complication of shingles. It is pain caused from damage to your nerves from the herpes zoster virus. Anyone who has had chickenpox is at risk of getting shingles. People get shingles because their immune system is compromised, or because it wears down as they age. The chickenpox virus that was dormant in the nerve tissues wakes up and causes a shingles attack. Postherpetic neuralgia is long-lasting nerve pain that can come after the shingles rash has healed.

Postherpetic neuralgia [pohst-her-PET-ik noo-RAL-juh] 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 doesn’t 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 won’t get chickenpox a second time.

But sometimes the body’s immune system becomes weaker or wears down over time, and the varicella zoster virus “wakes up” as herpes zoster. When this happens, it doesn’t 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 can’t 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 can often be prevented with an immunization. Although shingles can happen to people of any age, it’s most common in the elderly. The Centers for Disease Control and Prevention (CDC) recommends that people over 60 get the shingles vaccine, even if they’ve had shingles before. The vaccine can reduce the risk of getting shingles by 51% in those over 60 years of age and is effective for about 5 years.

Shingles is not contagious, but if you have a shingles rash, you can give chickenpox to someone (usually a child) who’s never had it before. The virus is spread by physical contact.

How Can Shingles Cause Postherpetic Neuralgia?

Sometimes, even though your shingles rash has come and gone, nerve pain continues in the area where you had the rash. Postherpetic neuralgia is nerve pain that lasts longer than 3 months after a shingles attack. The pain usually starts when the blisters of the shingles rash start to crust over and heal.

If herpes zoster was recognized and treated early, the symptoms are usually less severe. If you put off getting treatment for shingles, postherpetic neuralgia can cause significant suffering, last a long time, and be difficult to manage.

In rare cases, symptoms of postherpetic neuralgia happen on their own and not after shingles skin eruptions. This is a condition called zoster sine herpete.

Postherpetic neuralgia almost always happens after a shingles attack. It involves skin issues caused by damaged nerves, such as pain, numbness, and itching.

Symptoms include 3 types of pain:

1. Ongoing pain (such as continuous burning pain)
2. Shooting or electric-shock-like pains
3. Pain in response to light touch or other gentle skin stimulation

The pain one can feel with postherpetic neuralgia often changes, with levels that range from discomfort to severe pain. It is often located in 1 place on 1 side of the body, such as on the torso or on the face. If you get shingles on your face, it may damage or inflame the trigeminal [trahy-JEM-uh-nl] facial nerve and cause long-term facial pain. This condition is called trigeminal neuralgia.

Rarely, you might also experience muscle weakness or have other muscle-related problems if the damaged nerves also control muscle movement. 

If you feel a shingles attack coming on, the best way to reduce or possibly prevent long-term nerve pain is to treat the herpes zoster symptoms right away. See your doctor as soon as you can. If you have shingles already, your doctor will work with you to help manage the pain and other symptoms.

Postherpetic neuralgia is lingering nerve pain after a shingles attack. The pain usually starts when the blisters of the shingles rash start to crust over and heal. You may be diagnosed with it if your nerve pain has lasted longer than 3 months after the shingles attack.

If herpes zoster was recognized and treated early, the symptoms are usually less severe. Even so, postherpetic neuralgia can cause significant suffering, last a long time, and be difficult to manage.

Your doctor will do a physical examination and ask about your medical history. They will check sensory function (how well you sense touch, temperature, pressure, or pain) in the area where you had the shingles rash. They will want to know if you have had chickenpox or the varicella immunization as well as whether or not you have had previous attacks of shingles.

To assess your pain levels, the doctor will use a diagnostic tool called the Zoster Brief Pain Inventory or another questionnaire. They may also ask you to record your pain type and intensity in a diary to review together at your next visit.

Most of the time, doctors can diagnose postherpetic neuralgia with just the physical exam and an understanding of your medical history. Lab work is not usually needed.

Postherpetic neuralgia is difficult to treat. The nerve pain may continue for years or even for life. Treatment can involve:

• Topical ointments (such as lidocaine or capsaicin)
• Oral medicines (such as gabapentin, pregabalin, or tricyclic antidepressants)
• Opioid analgesics (used for some patients when other treatments are unsuccessful)

Even with these treatments, studies have shown that less than half of patients have complete pain relief. Adverse effects of treatment are also common and can be a problem, especially in older patients. Work with your doctor to come up with pain-management treatments and techniques that manage your symptoms.

For those who had the varicella vaccine that prevents chickenpox, long-term effects aren’t known yet. However, if the varicella vaccine prevents someone from getting chickenpox, and the virus doesn’t lay dormant in the body, it can’t later be reactivated as shingles. Preventing shingles is key to preventing postherpetic neuralgia.

However, many people have had chickenpox, which puts them at risk later for shingles and possible lingering nerve pain. A vaccination for herpes zoster called Zostavax® (by Merck) was approved in 2006. In October of 2017, the U.S. Food and Drug Administration (FDA) approved a new vaccine, Shingrix® (by GlaxoSmithKline). These vaccines can greatly reduce your chances of getting shingles and postherpetic neuralgia. The side effects of these vaccines are usually mild, such as a little irritation at the injection site.

If you feel a shingles attack coming on, the best way to reduce or possibly prevent long-term nerve pain from shingles is to treat and minimize the herpes zoster symptoms right away. See your doctor as soon as you can.

Center for Disease Control and Prevention

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