Causes of Postherpetic Neuralgia
Postherpetic neuralgia is a complication of shingles, a painful blistering rash caused by the reactivation of the varicella-zoster virus. Varicella-zoster virus is also the cause of chickenpox. There risk of developing postherpetic neuralgia increases with age. Additional risk factors include immunosuppression, severe pain during the shingles episode, and ocular involvement.
Symptoms of Postherpetic Neuralgia
Pain in the same distribution as the shingles rash, lasting greater than 3 months. Pain may be described as burning, sharp, stabbing, shooting, throbbing, or like electric shocks.
- Allodynia: increased sensitivity to pain
- Paresthesias: tingling, prickling, or “pins and needles”
- Dysesthesia: abnormal or unpleasant sensation in response to touch
- Itching
- Numbness
Impact of Postherpetic Neuralgia
The pain associated with postherpetic neuralgia can be severe and debilitating. Severe symptoms of postherpetic neuralgia can be physically, emotionally, and socially burdensome. Affected individuals may face challenges with sleep, appetite, and libido. Consult with your physician if you’re experiencing debilitating symptoms and/or changes in mood and energy levels.
Diagnosis of Postherpetic Neuralgia
Diagnosing postherpetic neuralgia is typically clinical, based on medical history and physical examination, though other diagnostic tests may be performed.
Medical History: Discussion of symptoms and past medical conditions.
Physical Examination: Examination of the area of pain, dermatologic examination, neurologic examination.
Treatment of Postherpetic Neuralgia
Treatment options for postherpetic neuralgia include:
Conservative Treatments: Non-surgical approaches include:
Pain Relieving Medications: Tricyclic antidepressants, such as amitriptyline, or anticonvulsants, such as pregabalin or gabapentin, may be used to relieve pain associated with postherpetic neuralgia. Topical treatments, such as capsaicin or lidocaine patches, may also provide some relief. In severe cases, opioids may be used to manage pain.
Hormonal Contraceptives: Oral contraception, intrauterine devices (IUDs), or other forms of hormonal birth control can help to regulate hormonal levels and reduce pain associated with endometriosis.
Additional Hormonal Therapies: Synthetic androgens, such as danazol, or GnRH agonists, such as buserelin or goserelin, may be used.
Pain Medicine Intervention: When conservative measures are ineffective or symptoms worsen, more invasive pain interventions may be considered:
Nerve Blocks: Targeted injections of local anesthetic near affected nerves to reduce pain.
Procedure Videos
Sympathetic Nerve Block Injection
Prognosis of Postherpetic Neuralgia
Postherpetic neuralgia pain typically decreases over the first year, but in certain cases pain can persist for years. However, there is no cure for postherpetic neuralgia, and many patients will continue to have symptoms to some extent.
References
Gruver C, Guthmiller KB. Postherpetic neuralgia. In: StatPearls. StatPearls Publishing; 2024.
Postherpetic Neuralgia. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia. Accessed December 6, 2024
Johnson RW, Rice ASC. Clinical practice. Postherpetic neuralgia. N Engl J Med. 2014;371(16):1526-1533.
