Overview
Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is a common complication of shingles, causing persistent burning pain in the nerves and skin, even after the rash and blisters of shingles have healed. The risk of postherpetic neuralgia increases with age, mainly affecting people over 60. There's no cure, but treatments can help ease the symptoms. For most people, postherpetic neuralgia tends to improve over time. The pain is usually limited to the area where the initial shingles outbreak occurred, usually on one side of the body. Symptoms may include long-lasting pain that feels burning, sharp, jabbing, or deep and aching.
Understanding the disease
Symptoms
The symptoms of postherpetic neuralgia include pain that lasts three months or longer after the shingles rash has healed, commonly felt as burning, sharp, jabbing, or deep and aching pain. Other symptoms may include stiff neck, pain when bending the head forward, mental confusion, strange behavior or altered speech, persistent vomiting, difficulty breathing or chest pain, abdominal pain, pain when urinating, convulsions or seizures, and an inability to bear even light touch on the affected skin. Postherpetic neuralgia may also cause itching or loss of feeling.
Risk Factors
Risk factors for developing postherpetic neuralgia include:
- Age: Being over 60 years old.
- Severity of shingles: Having a severe rash and pain that interferes with daily activities.
- Other illnesses: Having a long-term disease such as diabetes.
- Location of shingles: Having shingles on the face or torso.
- Delay in shingles treatment: Not starting antiviral medication within 72 hours of the rash appearing.
- Lack of shingles vaccine: Not being vaccinated against shingles.
Development
Postherpetic neuralgia (PHN) develops as a complication of shingles, which is caused by the varicella-zoster virus (VZV). When the VZV reactivates in the body, it can cause a painful rash and blisters, known as shingles. In some cases, the virus can damage the nerve fibers, leading to postherpetic neuralgia. The symptoms of PHN include persistent pain in the area where the shingles rash first appeared, which can last for months or even years. The risk of developing PHN increases with age, particularly for individuals over 60. Additionally, factors such as severe shingles rash, other long-term illnesses, and delaying treatment with antiviral medications can contribute to the development of PHN.
Assessment and Diagnosis
Triage
If postherpetic neuralgia is suspected, you should see a doctor if the pain is lasting three months or longer after the shingles rash has healed, or if the pain feels burning, sharp, jabbing, or deep and aching.
Diagnosis
To diagnose postherpetic neuralgia, a healthcare provider will typically examine your skin and might touch different areas to identify the affected region's borders. In most cases, no further tests are needed. However, if a tumor is suspected to be causing the pain, a CT scan or MRI might be ordered. Additionally, electromyography and nerve conduction studies may be conducted to evaluate muscle and nerve disorders, although these tests are generally not necessary for a clear diagnosis of postherpetic neuralgia.
Management and Treatment
Prevention
There is currently no known prevention for postherpetic neuralgia. However, getting vaccinated against shingles can help prevent the development of shingles and potentially reduce the risk of postherpetic neuralgia. Additionally, it's important to seek early treatment for shingles by starting antiviral medication within 72 hours of the rash appearing, as this may also help reduce the risk of postherpetic neuralgia.
Treatment
Treatments for postherpetic neuralgia include medications to manage pain, antidepressants to alleviate nerve pain, and topical creams or ointments. Pain management strategies such as physical therapy, relaxation techniques, and maintaining a healthy lifestyle can also help. Consult a healthcare provider for appropriate treatment options and to determine the best course of action for your specific case.
Preparing for medical consultation
To prepare for an appointment for postherpetic neuralgia, you should:
- Make a list of your symptoms, including their duration and frequency.
- Note any recent life changes, major stresses, and family medical history.
- List all medications, vitamins, or supplements you're currently taking, including doses.
- Bring a family member or friend along for support and to help remember information discussed during the appointment.
- Prepare a list of questions to ask your healthcare provider, such as treatment options, duration of symptoms, and potential side effects.
- Consider stopping capsaicin cream application a few days before the appointment to avoid any potential skin irritation. Remember to be as detailed and specific as possible when describing your symptoms to your healthcare provider. This will help them better understand your condition and provide appropriate treatment recommendations.