Postherpetic Neuralgia

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postherpetic-neuralgia-conditionsPostherpetic neuralgia (post-her-PET-icnoo-RAL-jah) is a complication of shingles, which is caused by the chickenpox (herpes zoster) virus. Most cases of shingles clear up within a few weeks. But if the pain lasts long after the shingles rash and blisters have disappeared, it’s called postherpetic neuralgia.

Postherpetic neuralgia affects your nerve fibers and skin, and the burning pain associated with postherpetic neuralgia can be severe enough to interfere with sleep and appetite. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. The area affected also makes a difference. When shingles occurs on the face, for example, the likelihood of postherpetic neuralgia is significantly higher than for other parts of the body.

Currently, there’s no cure for postherpetic neuralgia, but there are treatment options to ease symptoms. For most people, postherpetic neuralgia improves over time.

Symptoms

The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on just one side of your body.

Signs and symptoms may include:

  • Pain. The pain associated with postherpetic neuralgia most commonly has been described as burning, sharp and jabbing, or deep and aching.
  • Sensitivity to light touch. People who have postherpetic neuralgia often cannot bear even the touch of clothing on the affected skin, a condition called allodynia.
  • Itching and numbness. Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.
  • Weakness or paralysis. In rare cases, you might also experience muscle weakness or paralysis if the nerves involved also control muscle movement.

Causes

Once you’ve had chickenpox, the virus that caused it remains in your body for the rest of your life. As you grow older, the virus can reactivate. Sometimes this occurs when your body is stressed — because of another infection or due to medications that suppress your immune system, for example. The result is shingles. Because you have some immunity against the virus, rather than getting a full body rash, the rash occurs in areas of skin supplied by the nerve where the virus is reactivated.

Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers aren’t able to send messages from your skin to your 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.

Treatments and drugs

There is no single treatment that relieves postherpetic neuralgia in all people. In many cases, it may take a combination of treatments to reduce the pain.

Lidocaine skin patches

These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. These patches can be cut to fit only the affected area. You apply the patches, available by prescription, directly to painful skin to deliver temporary relief.

Capsaicin skin patches

These patches contain a very high concentration of an extract of chili peppers (capsaicin), which can be effective at relieving the nerve pain of postherpetic neuralgia. Capsaicin is available as a low-concentration cream over-the-counter and can improve pain over several weeks if the application is tolerated — it causes a burning sensation in many people. The capsaicin skin patch is a much higher concentration and is given only in your doctor’s office by trained personnel after first applying a numbing medication to the affected area. The process takes at least two hours, but a single application is effective in decreasing pain for some people for up to three months. If effective, the application process can be repeated every three months.

Anticonvulsants

Certain anti-seizure medications can lessen the pain associated with postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Doctors may prescribe gabapentin (Neurontin, Gralise), pregabalin (Lyrica) or another anticonvulsant to help control burning and pain. Side effects of these drugs include drowsiness, unclear thinking, unsteadiness and swelling in the feet.

Antidepressants

Certain antidepressants — such as nortriptyline (Pamelor), amitriptyline, duloxetine (Cymbalta) and venlafaxine (Effexor XR) — affect key brain chemicals that play a role in both depression and how your body interprets pain. Doctors often prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression alone. Common side effects of these medications include drowsiness, dry mouth, lightheadedness and weight gain. Side effects may vary depending on the antidepressant.

Opioid painkillers

Some people may need prescription-strength pain medications containing tramadol (Ultram, Ryzolt, Conzip), oxycodone (Percocet, Roxicet, Tylox) or morphine. Opioids can cause mild dizziness, drowsiness, confusion and constipation. They can also be addictive. Although this risk is generally low, discuss it with your doctor. Tramadol has been linked to psychological reactions, such as emotional disturbances and suicidal thoughts. These medications should not be combined with alcohol or other drugs and may impair your ability to drive.

Lifestyle and home remedies

 You may find that the following over-the-counter medications ease the pain of postherpetic neuralgia:

  • Capsaicin. Capsaicin cream, made from the seeds of hot chili peppers, may relieve pain from postherpetic neuralgia. Capsaicin (Capzasin-P, Zostrix) can cause a burning sensation and irritate your skin, but these side effects usually disappear over time. Capsaicin cream can be very irritating if rubbed on unaffected parts of your body. Follow the application instructions carefully, including wearing gloves for application and washing your hands thoroughly after applying.
  • Topical analgesics and anesthetics. Aspirin mixed into an absorbing cream or nonprescription-strength lidocaine cream may reduce skin hypersensitivity.