At a glance
What it is
A neuropathic pain syndrome that follows an outbreak of varicella zoster virus (shingles). The virus damages nerve fibres, causing chronic pain in the area where the rash first appeared.
Typical signs
Sharp, jabbing, burning, or deep aching pain in the affected skin area; extreme sensitivity to touch and temperature change; itching and numbness.
Approach
Multidisciplinary pain management: topical lidocaine, capsaicin, antidepressants, anticonvulsants, steroid injections, TENS, and pulsed radiofrequency ablation.
What postherpetic neuralgia is
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following an outbreak of varicella zoster virus (VZV), or "shingles." This is the same virus that causes chickenpox. During the initial infection, the virus remains in the body, lying dormant inside nerve cells. Years later, advanced age, illness, stress, decreased immune system function, or medications can reactivate the virus, causing the shingles outbreak. Sometimes, there is no apparent reason for the outbreak.
Once reactivated, the virus travels along nerve fibres, causing pain. When the virus reaches the skin, it produces a rash and blisters. A shingles outbreak usually resolves within a month or so. But some people continue to feel pain long after the rash and blisters heal. This pain is known as postherpetic neuralgia.
Not everyone who has had a reactivation of the virus develops postherpetic neuralgia. But PHN is a common complication of shingles in older adults. The greater your age when the virus reactivates, the greater the chance you will develop PHN. In most people, the pain of PHN lessens over time.
Signs and symptoms
Neuralgia is generally limited to the area of skin where the shingles outbreak first occurred. Symptoms may include:
- Sharp and jabbing, burning, or deep and aching pain - Extreme sensitivity to touch and temperature change - Itching and numbness - Headaches
Causes and risk factors
Postherpetic neuralgia results when nerve fibres are damaged during an outbreak of shingles. Damaged fibres are not able to send messages from the skin to the brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that may persist for months — or even years — in the area where shingles first occurred.
This complication of shingles occurs much more frequently in older adults. Less than 10 percent of people younger than 60 develop postherpetic neuralgia after a bout of shingles, while about 40 percent of people older than 60 do.
When to seek medical advice
See a doctor at the first sign of shingles. Treating shingles early — within three days of developing the rash — with oral antiviral drugs may actually prevent PHN. If you do develop PHN, see your doctor right away. Finding an effective treatment to relieve the pain can sometimes be frustrating. You may have to work with your doctor and sometimes other specialists to try a variety of treatments before you find something that helps.
Treatment options
Once PHN has occurred, a comprehensive, multidisciplinary pain management-oriented approach is helpful.
Topical therapies
- Lidocaine (Lidoderm) skin patches — prescription patches applied directly to painful skin
- Capsaicin cream (Capzasin-P, Zostrix) — made from hot chili pepper seeds; may irritate skin initially
Medications
- Antidepressants — affect serotonin and norepinephrine to modulate pain interpretation
- Anticonvulsants — gabapentin (Neurontin), pregabalin (Lyrica) stabilise abnormal nerve electrical activity
- Opiates — tramadol (Ultram) or oxycodone (OxyContin) for severe pain; may be habit-forming
Interventional procedures
- Steroid injections — corticosteroid injected around the spinal cord area
- Transcutaneous electrical nerve stimulation (TENS)
- Pulsed radiofrequency ablation
In some cases, treatment brings complete pain relief. But most people still experience some pain, and a few do not receive any relief. Although some people must live with postherpetic neuralgia for the rest of their lives, most people can expect the condition to gradually disappear during the first three months.
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about postherpetic neuralgia and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.