What is Postherpetic neuralgia (PHN) ?
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Explanation of medical terms and concepts
Postherpetic neuralgia (PHN)
Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles that affects the nerves and skin causing burning pain that lasts long after the rash and blisters of shingles disappear
Chickenpox (herpes zoster) causes shingles The risk of postherpetic neuralgia increases with age primarily affecting people older than 60. There is no cure for chickenpox but treatments can ease symptoms for most people Postherpetic neuralgia improves over time for most people
Symptoms Postherpetic neuralgia (PHN)
The signs and symptoms of postherpetic neuralgia usually begin in the area where shingles first appeared on your skin — usually around your trunk but sometimes on one side
Signs and symptoms might include:
- Pain that lasts three months or longerThe associated pain is described as burning sharp and jabbing or deep and aching
- Sensitivity to light touch.People with the condition often can't tolerate clothing touching their skin (allodynia)
- Itching and numbness.Less commonly postherpetic neuralgia can produce an itchy feeling or numbness
When to see a doctor
See a doctor at the first sign of shingles The pain can start before you have rash Your risk of developing postherpetic neuralgia is lessened if you begin taking antiviral medications within 72 hours of developing the shingles rash
Causes Postherpetic neuralgia (PHN)
Once you have chickenpox the virus remains in your body for the rest of your life If you develop an impaired immune system such as from medications or chemotherapy the virus can reactivate causing shingles
During an outbreak of shingles nerve fibers can become damaged Damaged fibers then cannot send messages from the skin to the brain as they normally do The messages become confused by over-exaggerating the normal signals and cause chronic pain that lasts months It can be years or even decades before the root problem is resolved
Risk factors Postherpetic neuralgia (PHN)
After you have had shingles you are at increased risk of developing postherpetic neuralgia (PHN) because:
- Age. You're older than 50.
- Severity of shingles. You had a severe rash and severe pain.
- Other illness.
- Shingles location. You had shingles on your face or torso.
- Your shingles antiviral treatmentYour rash appeared after your delay
Complications
With postherpes it depends on how long the condition lasts and how painful it is People who develop these symptoms could have chronic pain
- Depression
- Fatigue
- Difficulty sleeping
- Lack of appetite
- Difficulty concentrating
Prevention Postherpetic neuralgia (PHN)
The Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get a Shingrix vaccine to prevent shingles even if they have had shingles or the Zostavax Shingrix vaccine is given in two doses of two to six months apart
Shingrix is used to prevent shingles and post herpetic neuralgia Shingrix has been clinically proven to be 90% effective in preventing shingles and post herpetic neuralgia It should be used first followed by Zostavax but it can still be used for those over 60 years old if precautions are taken and anyone older who isn't allergic to Zostavax and doesn't take immune-suppressing medications
Diagnosis Postherpetic neuralgia (PHN)
Your doctor will examine your skin possibly touching it in places to determine the borders of the affected area
In most cases, no tests are necessary.
Treatment Postherpetic neuralgia (PHN)
No single treatment relieves postherpetic neuralgia for everyone Sometimes it takes a combination of treatments to reduce the pain
Lidocaine skin patches
These are small bandage-shaped patches that contain the topical pain-relieving medication lidocaine The patient cuts off a patch to fit only the affected area The patches available by prescription or over-the-counter at a slightly lower dosage can be applied directly to painful skin to deliver temporary relief When in doubt seek your own peace of mind and then you'll be able to find the path to resolve the conflict
Capsaicin skin patch
A high concentration of an extract of chili peppers is available as a skin patch to relieve pain Only your doctor can prescribe it and only trained personnel can apply it
The process takes at least two hours because you need to be watched after the high concentration patch is applied but a single application decreases pain for some people for up to three months If it works the application can be repeated every three months
Anticonvulsants
Certain anti-seizure medications can lessen the pain of postherpetic neuralgia These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves Side effects include drowsiness dizziness and confusion Feeling unsteady dizziness and swelling in the feet
Antidepressants
Certain antidepressants— such as Nortriptyline (Pamelor) Amitriptyline duloxetine (Cymbalta) and Venlafaxine (Effexor XR) affect brain chemicals that are involved in both depression and how your body interprets pain Doctors may prescribe antidepressants for postherpetic neuralgia Depression and pain in small doses than the amount of pain that occurs when the whole body is suffering
Common side effects of these medications include drowsiness dry mouth lightheadedness and weight gain
Opioid painkillers
Some people might need strong prescription painkillers containing tramadol (Ultram) or oxycodone (Percocet) or morphine These painkillers can cause mild dizziness drowsiness confusion and constipation
The CDC has recently issued guidelines suggesting that doctors should consider treatments other than opioid painkillers for people with non-cancer-related pain This is based on a growing recognition of the risk of addiction and death in some people using opioids
Prescription opioids should be monitored closely used at the lowest possible dose and considered only in situations where safer medications have failed In some cases controlled release medications and opioid antagonists can be used to treat pain
Opiates should not be combined with alcohol or other drugs
Steroid injections
Steroids are sometimes injected into the spine (intrathecal or epidural) for postherpetic neuralgia However evidence of their effectiveness is inconsistent A low risk of serious side effects including meningitis has been associated with their use
Lifestyle and home remedies
The following over-the-counter medications may relieve the pain of postherpetic neuralgia:
Capsaicin.Capsaicin cream made of hot chili peppers might relieve pain from postherpetic neuralgia Capsaicin (Capzasin-P Zostrix others) can cause a burning sensation and irritate your skin but these side effects usually disappear over time
Because capsaicin cream can make your skin itch avoid applying it to unaffected parts of the body Follow instructions for application wearing gloves and washing hands thoroughly after applying capsaicin cream
- Topical analgesics and anesthetics.Aspirin mixed with an absorbent cream or a nonprescription-strength lidocaine cream might reduce skin hypersensitivity
Preparing for your appointment
You might start by seeing your family doctor who may refer you to a neurologist or a specialist who treats chronic pain
This is information to help you prepare for your appointment
What you can do
Before you make an appointment ask if there is anything you need to do in advance such as fasting before a specific test Write down:
- Your symptoms,Do not include any questions that are unrelated to your appointment and when they began
- Key personal information,including major stresses of recent life changes family medical history and allergies
- All of your medications and vitamins or other supplements must be approved by the doctor before they can be given to patients you take, including doses
- Questions to ask your doctor
If you can take a family member or friend along when you go to receive the instructions
Ask your doctor about postherpetic neuralgia or PHN Here are some questions to ask your doctor:
- What's likely causing my symptoms?
- What else could cause my symptoms?
- What tests do I need?
- If my condition is likely temporary or chronic what kind of treatment do I need? If it is chronic what are the symptoms and how can they be treated?
- What's the best course of action?
- What are some alternatives to the primary approach you're suggesting?
- I have other health issues How can I best manage them together?
- Are there restrictions I need to follow?
- Should I see a specialist?
- Can I have brochures or other printed material what websites do you have good information on?
Don't hesitate to ask other questions
What to expect from your doctor
Your doctor is likely to ask you several questions, such as:
- How long have your symptoms lasted?
- How severe are your symptoms?
- Have you had chickenpox? When?
- Have you had a shingles vaccine?
- What is it that you think might be helpful in improving your symptoms?
- What if anything worsens your symptoms?
General summary
Postherpetic neuralgia (PHN) is a complication that can occur after having shingles It's caused by damage to the nerves that transmit pain signals to the brain The pain is usually described as aching burning or stabbing This complication can last for months or years after having shingles and may interfere with one's ability to sleep work and enjoy life and leisure activities
Postherpetic neuralgia is a pain condition that affects 10 to 20 percent of patients with shingles (also known as herpes zoster) Shingles occurs when the virus that causes chickenpox varicella zoster virus reawakens in the body later on during life and results in painful rashes After the shingles rash has disappeared and while there may be some still-visible marks left on the skin nerve inflammation can cause a burning sensation that lasts for several months or longer
How do you get rid of postherpetic neuralgia?
Postherpetic neuralgia is a type of nerve pain that can be extremely painful and difficult to treat The condition occurs when the herpes zoster virus causes shingles which is a rash caused by the chicken pox or herpes simplex virus This article discusses some natural treatments for postherpetic neuralgia as well as home remedies you may use to help combat this condition
What does postherpetic neuralgia feel like?
Postherpetic neuralgia is a nerve pain that may occur after shingles according to the National Institute of Neurological Disorders and Stroke It often develops within 3 months after a case of shingles although it can sometimes develop as long as 5 years later Symptoms of postherpetic neuralgia include burning pain that lasts for hours or days at a time along with numbness and tingling According to the NINDS postherpetic neuralgia affects up to 60 percent of people who have had shingles Pain relievers are options when experiencing symptoms of this condition
Is postherpetic neuralgia serious?
Postherpetic neuralgia is a chronic pain condition which can occur after the herpes zoster infection has cleared up This type of pain usually doesn’t appear immediately but rather 80% of people who experience shingles will find that it takes weeks or months to start feeling unwell again Some individuals have reported experiencing severe and debilitating symptoms for years These may include burning stabbing or intense sensations in their affected areas as well as fatigue depression and insomnia
Why is postherpetic neuralgia worse at night?
Postherpetic neuralgia or PHN is a condition that results from a shingles outbreak Shingles is caused by the varicella-zoster virus and attacks healthy nerve cells most commonly in an area affected by chicken pox Shingles develops on one side of your body and typically lasts three to five weeks However after the initial breakout period you may experience PHN for months or years afterward—particularly at night The pain can be extreme but medications such as gabapentin (Neurontin) can help lessen it
What foods should be avoided with postherpetic neuralgia?
For people who have postherpetic neuralgia certain foods may cause irritation to the mouth and lips because of their texture Foods that are most likely to cause discomfort include raw fruits and vegetables; hot or cold drinks; and very spicy seasonings
Does drinking water help with nerve pain?
There is no evidence that water consumption has a direct effect on nerve pain It may however help to hydrate the body and reduce any inflammation or swelling in the part of your body where you feel pain Additionally research has shown that adequate fluid intake is important for healthy nerve function 10-12 cups of water per day is recommended for men and women but some factors like exercise travel and environment can increase this amount so please talk with your doctor about what will work best for you
Is exercise good for postherpetic neuralgia?
Exercise is beneficial for both the body and mind It can help a person cope with the pain of postherpetic neuralgia or PHN When a person has PHN pain persists after shingles The pain of postherpetic neuralgia is caused by damaged sensory nerve fibers from previous attack of shingles that have been unable to regenerate fully Hence exercise should be encouraged in all patients suffering from PHN as it helps in improving their functional status and quality of life even if it does not result in any reduction in perceived intensity of pain or disability due to PHN However physical