What is Postherpetic Neuralgia?

If children get chickenpox, it can be easily dismissed and forgotten, but the virus that causes it remains in the body and may reemerge many years later in the form of shingles. Shingles is a more painful rash, and many people are glad when this rash begins to resolve about a month after it starts. Some unfortunately suffer a more complicated case of shingles and develop a condition called postherpetic neuralgia.

After the shingles blisters have cleared, people may experience continued pain and discomfort. Usually the area that hurts is the area where the shingles rash was present, though there are exceptions to this. In addition to extreme pain that feels sharp or deep, and sometimes both, the area may be sensitive to touch and temperature change, and might feel numb, dull or itchy. Unfortunately, in one sense, pain isn’t area-limited, because many people experience frequent headaches too, and some people might note weakness in the muscles.

These symptoms of postherpetic neuralgia are caused by nerve damage, which results when varicella zoster virus recurs as shingles. The impaired nerves may try to cope by sending mixed or incomplete signals to the brain, which the body often interprets as pain. In a small group of people, post-herpetic neuralgia persists for years despite treatment, and in others the condition resolves after months. Those who’ve had this condition can certainly attest that length of time it takes for the condition to resolve is part of the problem. Months or years can pass while people experience extreme pain.

Worse yet, risk of postherpetic neuralgia goes up as people age, especially once they are in their 60s or older. About half of people in this age group will develop postherpetic neuralgia from shingles, and available treatments may still leave almost 20% of those affected for a year’s time. The best treatment available is actually prevention in the form of the shingles vaccine for those who’ve had chicken pox and the chickenpox vaccine for those who haven’t had the condition. Especially for those 60 and older, the shingles vaccine called Zostavax® is highly recommended and reduces risk or the condition by about 60-70%. It’s also associated with shorter illness times if people do get shingles.

Not everyone has gotten the vaccine, however, and there are treatments for postherpetic neuralgia. These can sometimes include giving antidepressants, which may help change brain chemicals so that “false signals” from the nerves are ignored. Other potential treatments included prescribed pain medication, or steroids injected at the pain site.

Alternately, some people who have unresolved pain may benefit from electrical stimulation either on the skin or under it of the nerves around those nerves affected. This is called transcutaneous electrical nerve stimulation or peripheral nerve stimulation. Combinations of some of these treatments may help gradually improve symptoms, though there a few people with very stubborn cases of postherpetic neuralgia that will not benefit from any of these treatments.

Some people turn to alternative medicines like acupuncture, or herbal treatments instead when traditional medicine offers no cure for postherpetic neuralgia. One alternative medicine receiving serious scrutiny by the medical community is cream with capsaicin, which contains elements of chili peppers. There are many positive reports about capsaicin, and the fact that it is topical appeals because it means people can avoid taking pain medications that contain opiates.