Postherpetic neuralgia (post-her-PET-ic noo-RAL-jah) is a complication of shingles, which is caused by the chickenpox (herpes zoster) virus. Most cases of shingles clear up within a few weeks. But if the pain lasts long after the shingles rash and blisters have disappeared, it's called postherpetic neuralgia.
Postherpetic neuralgia affects your nerve fibers and skin, and the burning pain associated with postherpetic neuralgia can be severe enough to interfere with sleep and appetite. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. The area affected also makes a difference. When shingles occurs on the face, for example, the likelihood of postherpetic neuralgia is significantly higher than for other parts of the body.
Currently, there's no cure for postherpetic neuralgia, but there are treatment options to ease symptoms. For most people, postherpetic neuralgia improves over time.
The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on just one side of your body.
Signs and symptoms may include:
When to see a doctor
Once you've had chickenpox, the virus that caused it remains in your body for the rest of your life. As you grow older, the virus can reactivate. Sometimes this occurs when your body is stressed — because of another infection or due to medications that suppress your immune system, for example. The result is shingles. Because you have some immunity against the virus, rather than getting a full body rash, the rash occurs in areas of skin supplied by the nerve where the virus is reactivated.
Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers aren't able to send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that may persist for months — or even years.
Preparing for your appointment
While you may initially talk to your family doctor about your signs and symptoms, he or she may refer you to a nerve specialist (neurologist) or a doctor who specializes in the treatment of chronic pain.
What you can do
What to expect from your doctor
He or she may ask you how the pain is affecting your enjoyment of life, your sleep and your interactions with others. Your doctor may also review in detail medications you may have tried for this pain, including the dosages and any side effects you experienced. It's helpful if you have collected this information prior to your appointment. Finally, he or she will review your other medical conditions and medications before determining the best course of treatment for you.
Tests and diagnosis
In most cases, postherpetic neuralgia can be diagnosed during the office exam. No tests are usually necessary.
Treatments and drugs
There is no single treatment that relieves postherpetic neuralgia in all people. In many cases, it may take a combination of treatments to reduce the pain.
Lidocaine skin patches
Capsaicin skin patches
Lifestyle and home remedies
You may find that the following over-the-counter medications ease the pain of postherpetic neuralgia:
The herpes zoster vaccine (Zostavax) has been shown to decrease the risk of shingles by almost 70 percent. The vaccine has been shown to be effective and is approved by the Food and Drug Administration for adults age 50 and older and is recommended for all adults 60 and older regardless of whether they have had shingles in the past.
Last Updated: 2012-11-13
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