Roughly 20 percent of those diagnosed with shingles go on to suffer long-lasting pain from
post-herpetic neuralgia (PHN), a condition that can be more painful than shingles. Although
most people suffer with shingles for about a month, the pain and skin sensitivity can
continue for months or even years in some patients with PHN. PHN pain persists long after
the shingles rash heals. Although invisible, the virus of herpes zoster can cause damage to
the nerves, resulting in mild to severe pain. This pain of PHN may be sharp, piercing,
throbbing or stabbing and may result in intolerable skin sensitivity to even the lightest touch.
PHN occurs more often in older people and can last for months and even years.
However, for most people who develop PHN, the pain will gradually resolve with time. And
today there are multiple treatment options that do result in pain relief for those suffering
from PHN.
What is the source of the pain from PHN?
The pain results from damage to the nerve fibers during the shingles infection with the
herpes zoster virus. The pain of PHN is in the same area as the pain and rash of shingles.
Some PHN patients feel pain in the exact same location as the rash, others have PHN pain in
smaller areas within the rash region, and others feel the PHN pain in an area larger than the
original rash site.
Pain from nerve damage is among the worst types of pain. Consider a mild pain related to
nerve injury: the sensation when banging the "funny bone," the area in the elbow where a
major nerve crosses. Patients who have had a spinal tap, in which a needle pierces the
nerve-rich area of the back, describe this as one of the most painful procedures they have
ever had.
The pain of PHN is "deep and aching," "fire under the skin," "like electric shocks," and
"unbearable shooting pain." For some PHN patients, even a light touch, like the pressure of a
shirt, a gust of wind, or brushing the hair, can bring tears to the eyes. In other PHN
sufferers, the painful area is sensitive to slight changes in temperature.
Because the pain can be so intense, it can interfere with a person's life. For some PHN
sufferers, all normal activity comes to a halt for months. Depression is common in people
with PHN because of the severe pain and social isolation that can occur.
Who gets post-herpetic neuralgia?
On average, one of every five patients with shingles gets PHN. However, the risk of
developing PHN increases with age -- that is, the older the person is when getting shingles,
the more likely that PHN will develop.
Among those over the age of 55, 1 in 4 will develop PHN. Among those over 60, about half
will develop PHN. And among those over 70 and older, 3 of 4 persons have long-term pain
after the herpes zoster infection disappears from the skin.
TREATMENTS:
Topical lidocaine patch (lidoderm), lidocaine cream, EMLA cream or equivalent are used
initially. Antidepressants, specifically the tricyclic antidepressants such as Elavil, Pamelor, etc
are useful in the treatment. The anticonvulsants such as gabatril, zonegran, neurontin,
topamax, etc. may be useful in the treatment of PHN. Opiates (narcotics) are sometimes
used in severe cases of PHN. Capsaicin cream may be useful as are some compounded
creams with various combinations of the above medicines. TENS units may very occasionally
be useful. Spinal cord stimulation can be a very useful long term treatment. Steroids
injected into the cell body of the nerves transmitting the pain, or neurodestruction of the
nerves via cryoneurolysis or RF may be employed.
