Treating Pain When Shingles Pain Lingers

Post-herpetic neuralgia is challenging, but help is available

syringe and pills

Dealing with a case of shingles is painful enough. But once the skin rash resolves, a chronic pain syndrome called post-herpetic neuralgia (PHN) can sometimes develop.

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Studies suggest that roughly 30 to 60 percent of people over age 60 who get shingles — caused by the chickenpox virus, herpes zoster — go on to develop PHN.

A mysterious conditionin

Many things remain a mystery about this chronic condition, in which the herpes zoster virus affects the nerves and causes pain, usually involving the chest wall.

“We don’t know why some people get post-herpetic neuralgia and some don’t,” says pain management specialist Ellen King MD. “There’s plenty of speculation. The nerves may become more sensitive, or the virus may be reaching and damaging the central nervous system.”

Help is available

Fortunately, early treatment for shingles can lower your chances of getting PHN.

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“For some people, the pain becomes refractory, or resistant to treatment,” explains Dr. King. “So we want to treat shingles as fast as we can — ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.”

She adds that whenever nerve pain is involved, some people respond to treatment and some don’t. The virus cannot be removed from the nerves.

However, oral and injected medications that target the affected nerves may be able to “stun” the nervous system into behaving properly. That means transmitting the appropriate signal to the brain.

‘Rebooting’ the nervous system

“It’s like restarting a computer,” Dr. King says. “When it’s running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully it will send an appropriate transmission as opposed to a pain transmission.”

Treatment options for PHN patients include:

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  1. Intercostal nerve blocks: Injections of a local anesthetic between two ribs.
  2. Thoracic epidural injections: Anti-inflammatory medicine injected into the space around the spinal cord to decrease nerve root inflammation and reduce pain.
  3. Tricyclic antidepressants: Medications, such as amitriptyline, which may be used to relieve pain.
  4. Membrane stabilizers: Medications such as gabapentin, which can be used to reduce pain associated with PHN.
  5. Capsaicin cream: A topical cream that can be applied to the affected area to relieve pain temporarily.

Patients with refractory PHN rarely need opioid (narcotic) pain medication. “However, you should be evaluated by a physician. Treatment is individualized. We can’t make a blanket statement about it,” she says.

A word about the vaccine

If you are age 60 or over and have not had shingles, talk to your doctor about getting the shingles vaccine. Not only will it reduce your risk of developing shingles. If you do develop shingles, you’re likely to have a mild case.

And — just as important — you’re much less likely to develop PHN if you’ve had the vaccine.

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