Postherpetic Neuralgia
The words ‘postherpetic neuralgia’ may sound intimidating and rather confusing at first, but it is in fact a complication of shingles. Shingles (herpes zoster) comes from the reactivation of the varicella zoster virus, the virus that causes chickenpox. Once a person has had chickenpox, this virus stays in the body, which explains the potential reactivation. Postherpetic neuralgia is thus the nerve pain that persists despite the disappearance of the rash and blisters formed from shingles. What happens is that the nerve fibers are damaged as a result of shingles, and the hindrance in message communication between one’s skin and brain leads to chronic and exaggerated messages. This is the reason for the persistence in pain that has been described as burning, sharp, aching, and intense. Other causes of postherpetic neuralgia aside from this reactivation of the virus are an increase in age, as those above sixty years old are at a higher risk, and a suppressed immune system that would be unable to fight against virus reactivation.
A common symptom of postherpetic neuralgia is the burning pain that remains three months or more after the rash has healed. It generally develops in the area where the shingles outbreak is first located. The affected person would be extremely sensitive to touch and clothing-- even light clothing will be an irritant to the skin. Itching and numbness are also other symptoms, but they are less common than the pain and skin irritation. In addition, there can be a few complications in health that are caused by postherpetic neuralgia, such as depression, difficulty sleeping, difficulty concentrating, fatigue, and lack of appetite. These would depend on how long the postherpetic neuralgia lasts, as well as how painful the condition is.
There are six common types of treatment for postherpetic neuralgia, each with its own pros and cons. There is no cure for this sort of pain, but it will usually increase with time and effective treatment. A temporary relief for painful and affected areas can be provided by lidocaine skin patches, although it may result in dizziness, chest pain, blurred vision, bruising and blistering at the applied area, or drowsiness. Another option for skin patches are the capsaicin skin patches, derived from chili peppers. A highly concentrated amount should be used, although the treatment should only be performed by trained individuals. The capsaicin will help relieve pain by first stimulating and then decreasing the intensity of pain signals in the body. Treatment will take about two hours, but its effectiveness can last up to three months.
There are also three types of medications that can be taken. One is anticonvulsants or anti-seizure medications, which will decrease pain by stabilizing abnormal electrical activity in the nervous system that are caused by injured nerves. However, side effects include drowsiness, unclear thinking, and the swelling and unsteadiness of feet. The second type is antidepressants, which would be prescribed in smaller doses than the ones given to those with depression. Side effects include drowsiness, having a dry mouth, lightheadedness, and weight gain. The third type is opioid painkillers, although they can cause dizziness, constipation, confusion, and drowsiness, and may be addictive as well. One of the components is tramadol, which is linked to emotional disturbances such as having suicidal thoughts. Tramadol thus should not be taken in combination with alcohol or other drugs. Lastly, steroid injections into the spine are also an option. However, the level of effectiveness is inconsistent and varies among patients, and can lead to serious side effects such as meningitis, although it is at a low risk.
Postherpetic neuralgia can be prevented by receiving the herpes zoster vaccine Zostavax, as after all, it is a complication of shingles that leads to this pain disorder. It is recommended by the Food and Drug Administration that all adults over the age of sixty who are not allergic to vaccines and are not taking immune-suppressing medications should get this vaccine.
References:
https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588
