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Postherpetic neuralgia

Postherpetic neuralgia is pain that lasts for more than a month after a shingles infection occurred. The pain may last for months or years.

Causes, incidence, and risk factors

Postherpetic neuralgia occurs when the nerves have been damaged after an outbreak of shingles. Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox.

Postherpetic neuralgia is more likely to occur in people over age 60.

Symptoms

The main symptom is pain in the area where shingles once occurred.

  • The pain can range from mild to very severe. It may continue, or come and go.
  • The pain is described as a deep aching, burning, stabbing, or feeling like an electric shock.
  • People with this pain are very sensitive to touch or temperature changes.

The pain lasts for months or sometimes years after the shingles infection.

Treatment

Anticonvulsant drugs, usually used for seizures, may help with the pain of damaged nerves. Gabapentin and pregabalin are the ones most often used to treat postherpetic neuralgia.

Skin patches with lidocaine (a numbing medicine) may also be prescribed to relieve some of the pain for a period of time.

Pain medications are often needed. Sometimes acetaminophen or NSAIDs such as ibuprofen are enough. Many patients will need stronger, prescription drugs such as codeine, hydrocodone, or oxycodone.

Drugs used to treat depression (antidepressants) may also help reduce pain, as well as help with sleep.

Electrical nerve stimulators may be used for severe, long-term cases of postherpetic neuralgia.

Some people may need help from a pain specialist.

Prevention

A herpes zoster vaccine is available. It is different from the chickenpox vaccine that children or young adults may receive. Adults over age 50 should get the herpes zoster vaccine as part of their routine medical care.

A single shot of the vaccine can cut the risk of getting shingles by about half. It may also help prevent postherpetic neuralgia and ophthalmic herpes.

Because the vaccine contains a live virus, it cannot be given to people who have a weak immune system.

References

Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med. 2011;154:168-173.

Chen N, Li Q, Zhang Y, Zhou M, Zhou D, He L. Vaccination for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2011 Mar 16;3:CD007795.

Wilson IF. Herpes zoster. Ann Intern Med. 2011;154:ITC31-15.

Updated: 6/28/2011

Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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