What is Post Herpetic Neuralgia?

Post herpetic neuralgia explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Post-Herpetic-Neuralgia DiagramPost herpetic neuralgia is a condition that affects many different areas of the body. Believed to arise as the result of a virus, this condition can be associated with significant and widespread pain. Since the development of the chickenpox vaccine, there is some evidence for a decline in the condition. It is believed that the virus herpes zoster, the virus that causes chickenpox and is linked with shingles, is at the source of this condition. In fact, some studies have shown that individuals can reduce their risk for developing post herpetic neuralgia by as much as 67% when they are vaccinated against chickenpox. Evidence has also suggested that adults can be protected from post herpetic neuralgia by receiving the vaccine.

The specific symptoms of this condition can vary widely. For patients who have experienced a previous outbreak of shingles, they are more likely to experience post herpetic neuralgia pain within the same area of the previous outbreak. However, in other instances, the patient may experience pain that can spread throughout the body. The pain associated with post herpetic neuralgia can be described as constant and persistent or highly specific and very sharp stabbing pain. The onset of pain does tend to occur rapidly, and in some instances the pain can be quite severe. In many cases, the individual suffering from post herpetic neuralgia may be unable to tolerate even a light touch in the affected area. As with many other pain conditions, emotional stress can exacerbate the symptoms of pain and discomfort.

Causes of Post Herpetic Neuralgia 

Post-Herpetic-Neuralgia - SkinShingles is believed to be at the root of post herpetic neuralgia. Resulting in part from the herpes zoster virus, shingles is generally associated with a rash, blisters, excessive nerve inflammation, and even nerve damage. This nerve damage is thought to be the cause of pain in individuals with post herpetic neuralgia. More specifically, for cases of shingles in which the patient’s symptoms have not resolved following several weeks, they are considered to have the more chronic condition known as post herpetic neuralgia.

Most people develop a natural immunity to the herpes zoster virus during their childhood years, either from experiencing an outbreak of chickenpox or from receiving the vaccine. However, despite developing immunity, the herpes zoster virus can lie dormant within the body for a number of years. Thus, should the immune system be compromised during adulthood, there is a significant risk for reactivating the virus. This reactivation can occur either during a period when the person is undergoing a significant amount of stress or is taking a type of medication that acts to suppress the immune system’s functioning.

It is believed that the symptoms of pain associated with post herpetic neuralgia arise from nerve damage that occurred during a shingles outbreak. Thus, damage and irritation to the nerve fiber can cause the nerve bundle to transmit exaggerated signals of pain to the spinal cord and brain from the surface of the skin. These exaggerated signals can persist for several months to several years. While it is generally unusual for a patient to experience a very large outbreak that covers the entire body, most individuals experience a localized rash in the same general area where the virus was reactivated. In some instances, the patient can experience excessively severe and debilitating pain that can also be associated with disturbances in sleep and appetite.

There is currently no cure for post herpetic neuralgia. Individuals may lower their risk for developing an outbreak of post herpetic neuralgia by getting vaccinated. Otherwise, the symptoms of post herpetic neuralgia are expected to remit over time.

Treatments for Post Herpetic Neuralgia

Spinal Cord StimulatorGiven that there is currently no specific cure for the condition, the primary goal for treatment is to assist patients in managing the debilitating pain that is associated with the condition. Currently, there are several treatment options for patients to consider for managing the pain associated with post herpetic neuralgia.

Skin patches that contain capsaicin have been shown to provide some relief to patients with neuropathic pain from post herpetic neuralgia. While there are no presently approved medications for the treatment of post herpetic neuralgia, there are some pharmacotherapy options that patients may consider when exploring options for treatment. Anticonvulsants, such as gabapentin, are believed to provide patients with some relief from pain, particularly neuropathic pain. Some anti-depressant medications have also been shown to reduce the pain associated with post herpetic neuralgia.

In terms of patients who report that their pain has not been responsive to other medications, it may be recommended that they try more aggressive pain management techniques. For instance, opioid medications, such as codeine, may be prescribed for patients needing short-term relief from the pain of post herpetic neuralgia. These medications act by binding to the opioid receptors within the brain. There are significant risks, however, associated with the use of opioids, particularly long-term. These risks include the potential for addiction; in other words, patients may become psychologically or physically dependent on them.

Other methods, including the use of a TENS unit or spinal cord stimulation, which send a very mild electrical impulse to the affected area, have also been shown to be highly effective in relieving pain associated with post herpetic neuralgia.

Conclusion 

Generally linked to nerve damage following a shingles outbreak, post herpetic neuralgia is a chronic pain condition associated with severe and often debilitating pain. Symptoms of post herpetic neuralgia are generally limited to circumscribed areas of the body and can be exacerbated by emotional stress. In rare cases, the symptoms of post herpetic neuralgia are more widespread. Currently, there is no known cure for post herpetic neuralgia. Despite this, a number of treatment options exist to help patients manage the neuropathic pain associated with the condition. Patients should speak with their doctor about their specific condition and to learn about the treatment options available for managing their pain.

At Pain Doctor our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.

References

  1. Barbarisi M, Pace MC, Passavanti MB, Maisto M, Mazzariello L, Pota V, Aurillo C. Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clin J Pain. 2010;26(7):567-72.
  2. Derry S. Sven-Rice A, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2013;28.
  3. Gan EY, Tian EA, Tey HL. Management of herpes zoster and post-herpetic neuralgia. Am J Clin Dermatol. 2013;14(2):77-85.
  4. Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2013;28.
  5. Harden RN, Kaye AD, Kintanar T, Argoff CE. Evidence-based guidance for the management of postherpetic neuralgia in primary care. Postgrad Med. 2013;125(4):191-202.
  6. O’Connor KM, Paauw DS. Herpes zoster. Med Clin North Am. 2013;97(4):503-22.