Conditions We Treat

Post-Herpetic Neuralgia

Shingles (herpes zoster) is a viral disease caused by the same virus that causes chickenpox. Adults who had chickenpox as children may develop shingles later in adulthood. This illness causes a severe, long-lasting rash. The threat of post-herpetic neuralgia continues after the rash has faded. Post-herpetic neuralgia frequently causes pain that interferes with one’s quality of life.

woman with side back pain sitting on bed at home

This type of discomfort is felt on the same side of the body as the shingles outbreak, which is usually one side of the back, chest, or stomach. The most common symptom is a burning ache that prevents sleep and reduces appetite.

Other common symptoms include burning, stabbing, and jabbing pain; itching or numbness; muscle weakness or paralysis; and sensitivity to any touch. Some patients develop minor symptoms, like the shingles virus. Unfortunately, many people find the symptoms of shingles and the subsequent post-herpetic neuralgia excruciatingly painful and frequently incapacitating.

What Causes Post-Herpetic Neralgia?

Post-herpetic neuralgia may develop following a shingles outbreak in people who did not receive a chickenpox vaccination as a child. When nerves get injured during a shingles infection, the disease develops. Nerves become confused and stop communicating properly between the skin and the brain. As a result, there is a pain that can be so strong that even the slightest touch might inflict misery.

It’s worth noting that shingles patients who consult a doctor within 72 hours of the distinctive rash emerging and begin antiviral treatment are half as likely to develop post-herpetic neuralgia. Early intervention is crucial. The dormant chickenpox virus is carried by over 99% of adults over 40 in the United States, but there is good news. Shingles and post-herpetic neuralgia are preventable with a vaccine.

A shingles vaccine has kept many elderly persons safe from outbreaks since 2006.

According to the Centers for Disease Control and Prevention (CDC), a clinical trial including thousands of adults aged 60 and up found that Zostavax, the first shingles vaccine, lowered the incidence of shingles by slightly over half (51 percent) and the risk of post-herpetic neuralgia by 67 percent. The vaccine was most effective in people aged 60 to 69, but it also provided protection to older populations.

Shingrix, a novel shingles vaccine, is proven to be more effective in clinical testing, although it comes with an increased risk of side effects at the injection site. The CDC has begun to suggest Shingrix over Zostavax for those over 50. But consult your doctor to see which is best for you.

How is Post-Herpetic Neuralgia Diagnosed?

Your doctor will check your skin, possibly touching it in spots to evaluate the extent of the disease. In most circumstances, no testing is necessary.

Treatment Options for Post-Herpetic Neuralgia

There is no single treatment that alleviates postherpetic neuralgia for everyone. Some treatment options include:

1. Lidocaine Skin Patches:

These are little, bandage-like patches containing the topical pain reliever lidocaine. These patches can be helpful for covering the affected area. To provide temporary relief, apply the patches – available by prescription or over-the-counter at a slightly lower dose – directly to the hurting skin.

2. Capsaicin Skin Patch:

To treat pain, a skin patch containing a high concentration of chili pepper extract (capsaicin) is available (Qutenza). The patch, only available at your doctor’s office, is administered by qualified staff after a numbing medicine is applied to the affected area.

Because you must be monitored after the high-concentration patch is applied, the procedure takes at least two hours, yet a single treatment can reduce discomfort for some people for up to three months.

3. Anticonvulsants:

Certain anti-seizure drugs, such as gabapentin (Gralise, Horizant, Neurontin) and pregabalin (Lyrica), can treat postherpetic neuralgia pain. These drugs help to calm aberrant electrical activity in your nervous system due to damaged nerves. Drowsiness, muddled thinking, and foot swelling are all possible side effects.

4. Antidepressants:

Certain antidepressants, including nortriptyline (Pamelor), amitriptyline, duloxetine (Cymbalta), and venlafaxine (Effexor XR), impact important brain chemicals involved in both depression and pain perception. Doctors frequently prescribe antidepressants in lower doses for postherpetic neuralgia than they do for depression alone.

Drowsiness, dry mouth, lightheadedness, and weight gain are common side effects of these drugs.

5. Opioid Analgesics:

Some people may require pain relievers containing tramadol (Ultram, Conzip), oxycodone (Percocet, Roxicet), or morphine. Opioids might cause dizziness, drowsiness, disorientation, and constipation in some people.

However, recent CDC guidelines urge doctors to seek non-opioid pain therapies. It is due to a growing awareness of the risk of addiction and death.

If prescribed, opioids must be thoroughly monitored, used at the lowest feasible dose, and considered only when safer drugs have failed. Opioids can impair your driving skills and should not be used with alcohol or other substances.

6. Steroid Injections:

For postherpetic neuralgia, steroids are administered into the spine (intrathecal or epidural). Their use has been linked to a low incidence of significant side effects, including meningitis.

7. Vaccination:

The Centers for Disease Control and Prevention (CDC) recommends that persons 50 and older obtain the Shingrix vaccine to prevent shingles, even if they’ve already had shingles or the earlier Zostavax vaccine. Shingrix is administered in two doses spaced two to six months apart.

According to the CDC, two doses of Shingrix are more than 90% effective in preventing shingles and postherpetic neuralgia. Shingrix is preferable to Zostavax. The effectiveness of Zostavax may be maintained for a longer time. Zostavax may still be administered sometimes for healthy persons aged 60 and up who are not allergic to Zostavax and do not take immune-suppressing drugs.

Improving Patients’ Quality of Life Through Personalized Care

If you’re struggling with neck, back, or hip pain or any other spine related issues, schedule an appointment with us today to get back to living your life the way you’d like to.

Common Conditions We Treat