Dr. Nick Scott discusses Postherpetic Neuralgia. Watch this video and learn about symptoms and treatments for Postherpetic Neuralgia.
Pain Doctor Nick Scott Talks About Postherpetic Neuralgia.
Postherpetic neuralgia is a painful nerve and skin condition caused by shingles – or the virus herpes zoster. The same virus is responsible for causing chickenpox in children. Postherpetic neuralgia is the on-going pain associated with a shingles outbreak.
Perhaps the most disturbing worry for those who have a shingles outbreak is the threat of postherpetic neuralgia. This side effect of shingles is a painful nerve and skin condition caused by the virus herpes zoster. The same virus is responsible for chickenpox in youth and inexplicably causes shingles in some adults. In turn, postherpetic neuralgia is the persistent, often quality of life altering pain associated with a shingles outbreak.
Shingles and related postherpetic neuralgia are entirely preventable via vaccine. Since 2006, a shingles vaccine has kept many older adults free from such outbreaks. Health officials at the Centers for Disease Control and Prevention (CDC), report a clinical trial involving thousands of adults 60 years old or older, showed Zostavax — the shingles vaccine — reduced the risk of shingles by about half (51%) and the risk of postherpetic neuralgia by 67%. The vaccine was most effective in people age 60–69, but also provided some protection for older groups. Research continues on how long the vaccine lasts; current data show the vaccine protects adults from the illness, and the painful side effects, for at least six years. Those age 60 and older should request a Zostavax vaccine from their pain physician or general practitioner as a smart method of prevention.
Postherpetic Neuralgia Diagnosis and Symptoms
Postherpetic neuralgia symptoms include a burning pain that may influence sleep and appetite. For most who suffer from shingles, the rash and blisters associated disappear within three weeks, along with any pain from the outbreak. However, a small minority of shingles patients will go on to have pain that lasts months or years after the outbreak. This is caused by nerve fibers that are damaged during the shingles outbreak. As a result, the nerves cannot properly send messages between the skin and the brain. The product of this confusion is chronic, intense pain.
Postherpetic neuralgia is typically found in the same site on the body where the shingles outbreak initially occurred – usually one side of the back, chest or stomach.
Other symptoms may include:
- Pain: burning, sharp and jabbing, or deep and aching
- Itching or numbness: the skin may become itchy or numb
- Weakness: muscle weakness or paralysis of muscle control movement nerves is rare, but has been reported
- Sensitivity to any touch: even the touch of clothing on the affected skin can cause excruciating pain
Timing is essential in the prevention and treatment of postherpetic neuralgia. A vaccine is now available to prevent shingles. It is recommended all adults age 60 and older receive the vaccine to prevent a herpes zoster outbreak in the first place. However, for those who are unvaccinated and suspect they are becoming ill with shingles, seeing a pain physician within the first 72 hours is imperative. Research shows those who start antiviral medications for shingles within 72 hours of developing the signature rash are 50% less likely to develop postherpetic neuralgia.
Postherpetic Neuralgia Treatments
During a visit with a pain physician, a postherpetic neuralgia patient should be prepared to answer a series of questions about the shingles outbreak, the symptoms suffered, the forms of pain relief already exhausted, etc. There is no specific test for postherpetic neuralgia, nor is there a specific cure. However, a variety of pain medications and options may be prescribed until the patient and physician find the right combination. These may include: antidepressants, anticonvulsants, pain relieving skin patches, opioids, topical pain creams.
A pain physician will likely ask the duration of the pain, other symptoms the patient is experiencing, how the pain influences daily activity, the other medications and supplements being taken and the forms of pain relief that have already been exhausted. Extensive diagnostics are not required for postherpetic neuralgia. A trained pain physician should be able to diagnose the condition during an office exam and prescribe a treatment option. There is no cure for postherpetic neuralgia, nor one answer for the pain. Patients often are prescribed a combination of the following until the right combination is determined: antidepressants, anticonvulsants, pain relieving skin patches, opioids, topical pain creams.
The best bet to keep postherpetic neuralgia from occurring is to receive the varicella-zoster vaccine prior to a shingles outbreak. According to officials at the Centers for Disease Control and Prevention (CDC), a clinical trial involving thousands of adults 60 years old or older, Zostavax — the shingles vaccine — reduced the risk of shingles by about half (51%) and the risk of post-herpetic neuralgia by 67%. The vaccine was most effective in people age 60-69 and provided some protection for older groups. Research continues on how long the vaccine lasts; at this time, it is thought to protect adults from the illness, and the painful side effects, for at least six years.