Postherpetic Neuralgia
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Postherpetic neuralgia, a common aftermath of shingles, presents as a lingering burning sensation affecting the nerves and skin. The pain from shingles can persist long after the rash and blisters have healed. The risk of encountering this condition escalates with age, especially in those aged 60 and above. Although there is no definitive cure, there are treatments aimed at mitigating the symptoms. Over time, many people experience a natural improvement in their condition.
Symptoms
Typically, the symptoms of postherpetic neuralgia are confined to the region of skin where the initial shingles outbreak occurred, often appearing as a band around the body’s trunk, predominantly on one side. These symptoms may encompass:
- Hypersensitivity to light touch, rendering individuals with postherpetic neuralgia intolerant to even the gentlest contact of clothing on the affected skin.
- Persistent pain persisting for three months or more following the resolution of the shingles rash. The pain may manifest as burning, sharp, jabbing sensations, or deep, aching discomfort.
- In somecases, postherpetic neuralgia may induce sensations of itchiness or numbness.
Seek medical attention promptly upon observing the initial symptoms of shingles. Pain may begin before the rash becomes apparent. Commencing antiviral medications within 72 hours of the shingles rash onset can reduce the risk of developing postherpetic neuralgia.
Causes
Shingles, caused by the chickenpox virus, emerges when the virus, which remains dormant in your body after a bout of chickenpox, reactivates later in life. The chance of this virus becoming active again grows as people age or if their immune system weakens, for instance, due to chemotherapy treatments.
When shingles flares up, it can damage nerve fibers, which may lead to a condition called postherpetic neuralgia. This condition arises due to disruptions in the typical communication pathway between the skin and the brain, resulting in confused and intensified messages. Consequently, individuals may experience prolonged pain lasting for months or even years.
Risk factors
Factors that can elevate the risk of developing postherpetic neuralgia in individuals with shingles include:
- Age: Being over 60 years old.
- Severity of shingles: Experiencing a severe rash and debilitating pain that hindered daily activities.
- Location of shingles outbreak: Affected areas on the face or torso.
- Delayed treatment: Failing to initiate antiviral medication within 72 hours of rash onset.
- Coexisting illnesses: Having a chronic condition like diabetes.
- Lack of shingles vaccination: Not having received the shingles vaccine.
Diagnosis
During your consultation, your doctor will perform a thorough examination of your skin, which might include gently pressing on different areas to clearly define the extent of the affected zone. For the vast majority of patients, this examination suffices, and further tests are often not required.
Treatment
There is no one-size-fits-all treatment for postherpetic neuralgia. Often, a combination of treatments is necessary to alleviate the pain.
Lidocaine skin patches
These patches are small and bandage-like, containing lidocaine, a pain-relieving medication. They can be trimmed to fit the affected area precisely. Applying these patches to painful skin provides short-term relief. Your doctor may prescribe them, or they can be purchased over-the-counter at a slightly lower dose. It’s important to store them out of reach of children.
Capsaicin skin patch
Capsaicin, extracted from the seeds of spicy chili peppers, is formulated into a high-concentration skin patch known as Qutenza, designed for pain relief. This patch is available through your healthcare provider. Before applying the patch, a healthcare professional will apply a numbing cream to the targeted area to minimize discomfort. The procedure requires a minimum of two hours to complete, during which time the patient is observed for any adverse reactions. For some patients, this treatment can diminish pain for up to three months, and if effective, the treatment can be repeated every three months with a new patch.
Antidepressants
Certain medications used to treat depression can have effects beyond alleviating mood disorders. They influence important brain chemicals involved in both depression and pain perception. These medications can be beneficial for managing pain even in individuals who do not have depression. Examples of such medicines include:
- Nortriptyline
- Amitriptyline
- Duloxetine
- Venlafaxine
Doctors frequently prescribe antidepressants for postherpetic neuralgia at lower doses compared to those used for treating depression alone.
Typical side effects of these medications include drowsiness, dry mouth, faintness, and weight gain.
Anticonvulsants
Certain anticonvulsant medications can also provide relief from the pain associated with postherpetic neuralgia. Examples include gabapentin and pregabalin. These medications work by soothing damaged nerves.
Potential side effects include include drowsiness, difficulty thinking coherently, feeling instability, and swelling in the feet.
Opioid painkillers
Doctors may prescribe opioids, which are potent pain medications, for individuals with postherpetic neuralgia. Some may require medications containing tramadol, oxycodone, or morphine.
Potential side effects of opioids include confusion, mild dizziness, sleepiness, and difficulty with bowel movements.
An opioid may be recommended for postherpetic neuralgia only if other safer treatments have proven ineffective. Before initiating opioid therapy, your doctor should:
- Describe the dangers and advantages of the medication.
- Establish goals for your pain management program.
- Create a plan to assist you in safely stopping the medication if the dangers become too great.
Opt for the lowest effective dose of opioids. Additionally, adhere to your doctor’s recommended schedule for check-ups.
Driving under the influence of opioids can pose significant risks. It is also unsafe to combine opioids with alcohol or other medications.
Steroid injections
Injections of steroids into the spine may provide relief for certain individuals with postherpetic neuralgia.
