Post-Herpetic Neuralgia (post-shingles pain)

Post-herpetic neuralgia, or PHN, is a painful syndrome that primarily affects adults over 60 years of age.  It results from an infection of shingles (Herpes zoster), which is the same virus that causes chicken pox.  Whenever a person has had chicken pox, the virus remains within the nervous system, usually in a dormant state.  During times of suppressed immune activity, the virus can migrate out of the spinal cord and along nerves to the skin, most commonly in the chest or trunk, but can even involve the face and eye.

The shingles infection is usually characterized by very painful blisters, which contain fluid rich in the chicken pox virus.  It often takes several weeks for the shingles infection to heal, and should be treated with an antiviral medication, such as acyclovir, if recognized early.  PHN results when the pain does not resolve even after the blisters and rash have healed.  It is generally described as a burning pain, which is worsened by touching the skin, or by clothing rubbing against the skin.  Unfortunately, PHN can last for a lifetime, and can greatly reduce quality of life.

Vaccination against chicken pox is the best preventive measure for post-herpetic neuralgia.  However, for those who contracted chicken pox as a child, there is a vaccination for shingles, and should be given to anyone over the age of 60.

Treatment for post-herpetic neuralgia should be undertaken as early as possible, even while the active infection is still present.  Antiviral medication can reduce the severity and duration of shingles.  Nerve blocks and epidural steroid injections may also help reduce the severity and pain of the infection.  Once the pain has become chronic, there are several medications which may help reduce the pain, but there is no cure.  The approved medications to treat PHN include 5% lidocaine patches, which can be placed over the painful skin; pregabalin (Lyrica) and gabapentin (Gralise), which are anti-epilepsy medications which often reduce the painful nerve impulses; topical capsaicin, found in chiles (Qutenza).  Opioid medications (morphine-related drugs) are often prescribed, and are sometimes effective for PHN.  Implanted spinal devices, such as spinal cord stimulators and infusion pumps may be used in severe intractable pain.

Please see my website: http://svpaindoc.com for a more detailed description of some of these treatments.  PHN can be treated!