Postherpetic Neuralgia - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Postherpetic neuralgia refers to pain that remains after an outbreak of varicella zoster (also known as shingles). Postherpetic neuralgia develops in approximately 6% of those that develop shingles[1] and can be very painful and affect quality of life.

Symptoms

Post-herpetic neuralgia is the presence of intense nerve-related pain that can develop after an outbreak of shingles (herpes zoster). This pain can feel like intense shooting, stabbing, or burning pain. In some cases, even the lightest touch can be very uncomfortable to the point that clothes or any movement can be painful. 

Causes

People who have had chicken pox are at risk for the development of an outbreak of shingles. Varicella zoster virus is a human herpes virus that after primary infection as chicken pox, becomes latent or dormant in nerves. The virus can reactivate to cause zoster (shingles).  Often some sort of immunosuppression due to age, other medical condition or stress can allow the virus to reactivate and cause a shingles eruption. 

 

Treatments

Treatment is largely systemic and topical therapies are typically not effective on their own. 

  • Lidocaine: Topical anesthesia can help to reduce the nerve pain.[2]  
  • Capsaicin: Capsaicin helps to reduce the sensitivity of nerves and may be helpful in reducing the pain and nerve sensitivity seen in postherpetic neuralgia.[2]
  • Antiviral medications: Therapy with an antiviral medication such as acyclovir, valacyclovir or famcyclovir can be given during active infection to help reduce the symptoms of the active outbreak. It is debatable if treatment during active infection helps decrease the postherpetic pain that may ensue. Early treatment within 72 hours of infection onset is best. In some cases oral prednisone can be given additionally if symptoms are severe.[2]
  • Nerve sensation modulators: Other systemic medications that can be given during the postherpetic period to treat neuralgia include gabapentin, tricyclic antidepressants, carbamazepine, pregabalin and narcotics. 
  • Pain management: Medications such as aspirin may help with pain control. Stronger pain medications can be discussed with a qualified healthcare provider. 

1.    Forbes HJ, Bhaskaran K, Thomas SL, et al. Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: A cohort study. Neurology.2016;10.1212/WNL.0000000000002808PMID: 27287218.

2.    Kennedy PG. Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV). Neurotherapeutics.2016;10.1007/s13311-016-0430-xPMID: 27032406.