Dealing with a case of shingles is painful enough. But once the skin rash resolves, a chronic pain syndrome called postherpetic neuralgia (PHN) can sometimes develop.
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Studies suggest that roughly 30% to 60% of people over age 60 who get shingles — caused by the chickenpox virus, herpes zoster — go on to develop PHN.
A mysterious condition
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. It causes a burning or stabbing sensation in the area where the shingles outbreak first occurred.
“We don’t know why some people get post-herpetic neuralgia and some don’t,” says pain management specialist Ellen Rosenquist, 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 for PHN
Fortunately, early treatment for shingles can lower your chances of getting PHN.
“For some people, the pain becomes refractory, or resistant to treatment,” explains Dr. Rosenquist. “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, medications taken orally or injected that can 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. Rosenquist 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:
- Intercostal nerve blocks: A local anesthetic can be injected between two ribs.
- Thoracic epidural injections: Anti-inflammatory medicine can be injected into the space around the spinal cord to decrease nerve root inflammation and reduce pain.
- Tricyclic antidepressants: Medications such as amitriptyline may be used to relieve pain.
- Membrane stabilizers: Medications such as gabapentin can be used to reduce the pain associated with PHN.
- Capsaicin cream: This topical cream 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. We can’t make a blanket statement about treatment. It is individualized,” she says.
A word about the shingles 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, but if you do develop shingles, you’ll be more likely to have a mild case. And, just as important, you’ll be much less likely to develop PHN if you’ve had the vaccine.
