Post-herpetic neuralgia affects nerve fibers and skin, which causes a burning sensation. The sensation is painful at times and will lasts long after the rash and blisters of shingles are gone. This condition is a complication of shingles, which is caused by the chickenpox (herpes zoster) virus. Age is the primary factor in this disorder, and the risk rises age we age. Affecting more people sixty, post-herpetic neuralgia has no cure at the time. However, treatments can ease symptoms. For most people, post-herpetic neuralgia improves over time.
Once you’ve been exposed to the chickenpox virus, it will remain in your body for the rest of your life. If your immune system is suppressed, from medications or chemotherapy, the virus can reactivate, causing shingles. Again, age is plays a factor in getting post-herpetic neuralgia. If your nerve fibers are damaged during an outbreak of shingles, post-herpetic neuralgia may occur. Damaged fibers can’t send messages from your skin to your brain, as they normally do, and the messages become jumbled. The damaged fibers cause chronic pain, and many times, deliberating pain that can last months to years.
Postherpetic neuralgia risk increases with age. The condition rarely affects people under 50 years of age. For people who have had acute herpes zoster, postherpetic neuralgia affects 20% of those 60 to 65 years of age, and 30% of those age 65 and older. Around 2% of people continue to have pain after one year. The incidence of post-herpetic neuralgia is 3.4 per 1,000 persons younger than 50 years, and 5-10 per 1,000 persons for those older than 50 years.
Post-herpetic neuralgia symptoms normally show up to the area of your skin where the shingles broke out in the first place. The band around your trunk area is the most common site for shingles to occur. Many times, shingles affect only one side of the body, but both sides can develop the rash. Post-herpetic neuralgia has been known to show up on people’s faces where shingles occurred before. Symptoms and signs may include:
It’s a good idea to see a doctor at the first sign of a shingles outbreak. Many times, you will notice a pain before you notice a rash. If you start taking antiviral medications within 72 hours after developing the rash, your risk of developing post-herpetic neuralgia is much lesser.
When you see your doctor, tell them about your symptoms, and how you feel. Your doctor will examine your skin, and many times, be able to determine the borders of the affected area. Some doctors will do blood test to rule out any other disorders. The doctor may ask about the above symptoms to see if your condition is associated with them. Depending on how long post-herpetic neuralgia lasts and how painful it is, people with the condition can develop:
In many cases, it takes a combination of treatments to reduce the pain of post-herpetic neuralgia because many times a single treatment can’t reduce the pain in most people. Treatment options include:
Capsaicin skin patch. A patch, which is an extract of chili peppers in high concentration, is applied by trained personnel after using a numbing medication on 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 it works, it can be repeated every three months.
Lidocaine skin patches. Available by prescription, you apply patches directly to the painful skin to deliver temporary relief. These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. The patches can be cut to fit the area needed.
Antidepressants. Certain antidepressants affect key brain chemicals that play a role in both depression and how your body interprets pain. These antidepressants are usually prescribed by doctors in smaller doses than they do for depression alone. They have side effects which include dry mouth, lightheaded feelings, weight gain and at times, drowsiness.
Anticonvulsants. Certain anti-seizure medications can lessen the pain of post-herpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Side effects of these drugs may include foggy thinking, drowsiness, feet swelling, and an unsteady feeling.
Steroid injections. At times, the pain is so severe, the use of steroids is used. A corticosteroid is injected into the epidural space, which surrounds the spinal cord. Epidural steroid injections are often given in a series of three, spaced 3 to 6 months apart.
Opioid painkillers. Prescription-strength pain medications have been prescribed for some people. Opioids may cause some confusion, mild dizziness, drowsiness, and many times, constipation. Some people have become addicted to these medications. Suicidal thoughts have been linked to psychological reactions to tramadol. Opioid medications should not be combined with alcohol or other drugs. Driving or operating any machinery may be dangerous while taking them.
Spinal Cord Stimulator. As a last resort option, a stimulator may be helpful. While this doesn’t cure the issue, it can mask the pain well. The outpatient procedure includes a permanent implant that has over 200 options.
Dr. Ajay Yeddu offers comprehensive treatment options for postherpetic neuralgia in Arizona, including Gilbert, Chandler, Mesa, Queen Creek, San Tan and Maricopa AZ. Most insurance is accepted, call DISC today!