Uncovering Post Herpetic Neuralgia

Perhaps the most disturbing worry for those who have a shingles outbreak is the threat of post herpetic 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 inexplicably causes shingles in some adults. In turn, post herpetic neuralgia is the persistent, often quality- of-life-altering pain associated with a shingles outbreak.

Yet – there is good news. Shingles and related post herpetic 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 post-herpetic 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.

For those without the vaccine, post herpetic neuralgia may develop after a shingles outbreak. The most common symptom is a burning pain that keeps the patient from sleep and diminishes appetite. Shingles patients who are able to see a pain physician within the first 72 hours of the signature rash appearing and can start a course of antivirals are half as likely to develop post herpetic neuralgia. The condition is caused when nerves are damaged during a shingles outbreak. The nerves become confused and no longer communicated properly between the skin and the brain. The result is sharp, annoying pain that may be so severe, the lightest touch can cause agony. Post herpetic neuralgia pain is typically located at the same site on the body where the shingles outbreak initially occurred – usually one side of the back, chest or stomach.

Other common symptoms include:

  • Burning, sharp and jabbing pain
  • Itching or numbness
  • Muscle weakness or paralysis
  • Sensitivity to any touch

During a visit with a pain physician, a post herpetic 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 post herpetic 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.


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