What
is post herpetic neuralgia?
Post herpetic neuralgia is pain that remains where the rash from
shingles occurred long after the rash has healed. Shingles is an
infection of the nerves caused by the varicella-zoster virus, the
same virus that causes chickenpox. The medical term for shingles is
herpes zoster.
About one-third of the people who get shingles will get post
herpetic neuralgia. The pain can last for months to years after the
shingles outbreak. The older you are, the more likely you are to
develop post herpetic neuralgia. Typically, the worse the rash, the
more likely the pain will be severe and long-lasting.
How does it occur?
Most people in the US get chickenpox as children. Once the
chickenpox infection has cleared, the virus lies dormant inside
nerve roots.
Years later, if your immune system gets very stressed or weak, the
virus can reemerge. Instead of causing chickenpox to reoccur, it
causes shingles, which produces a painful, blistering rash. If pain
remains after the blisters have dried up and gone away, you have
post herpetic neuralgia. The pain is due to damage to the nerves.
Your immune system can be stressed or weakened by:
• normal aging
• chronic diseases such as rheumatoid arthritis
• cancer and cancer treatment
• certain medications
• strong infections such as pneumonia or by being immune-compromised
as with AIDS
One or more of these conditions can cause the virus to become active
again. If shingles results, so does the possibility of post herpetic
neuralgia.
What are the symptoms?
The pain of post herpetic neuralgia may be stabbing, aching,
burning, and constant. Some people can become overwhelmed and
depressed by having to cope with ongoing pain daily.
Post herpetic neuralgia may also result in:
• fatigue
• loss of appetite
• loss of enjoyment
• inability to perform usual daily tasks because of the pain
How is it diagnosed?
There are no special tests for post herpetic neuralgia. The
diagnosis is based on having pain that persists after the rash of
shingles has disappeared.
How is it treated?
A variety of treatments have been tried to ease the pain of post
herpetic neuralgia. What is effective for one person may not be for
another. If a treatment does not work, tell your health care
provider.
Your provider might prescribe:
• medications in the form of creams or pills
• acupuncture
• transcutaneous electrical nerve stimulation (TENS)
• cold packs
• interventional therapy such as nerve blocks
How long will the effects last?
The pain can last for months to years.
How can I take care of myself?
You may find the following helpful:
• Take all medicines as directed by your health care provider.
• Let your provider know what in your treatment plan works and what
doesn't.
• Eat a healthy diet that is low in saturated fats and includes
fruits and vegetables that can help to keep your immune system
strong.
• Get enough sleep.
• Get 20 to 30 minutes of aerobic exercise (such as walking or
swimming) daily.
• If you are feeling emotionally overwhelmed by daily pain, let your
health care provider know. You may want to look within your
community for chronic pain support groups.
What can be done to prevent it?
A vaccine is now available for the varicella-zoster virus that
protects against chickenpox and the development of shingles and post
herpetic neuralgia later in life. The vaccine is effective for those
who have never had exposure to the virus, so it will not be helpful
for most adults in the US. Eventually, as more children are
vaccinated for the virus, chickenpox outbreaks should become less
widespread and fewer adults will get shingles.
Tell your health care provider if you suspect that you are
developing shingles because early drug therapy may help shorten the
length of symptoms. Talk to your doctor to see if such therapy is
appropriate for you.
Last revised: February
12, 2010
by Jay Hurh, MD, MPH
