Postherpetic neuralgia is a painful condition affecting the nerves and skin. It’s a complication of shingles. The shingles pain remains even after the rash and blisters clear up.
Shingles is a painful, blistering skin rash caused by a reactivation of the varicella-zoster virus.
People usually contract this virus in childhood or adolescence as chickenpox. The virus can remain dormant in the body’s nerve cells after childhood and reactivate decades later.
Postherpetic neuralgia is the most common shingles complication. It occurs when a shingles outbreak damages the nerves.
The damaged nerves can’t send messages from the skin to the brain, and the messages become confused. This results in chronic, severe pain that can last for months.
According to a 2017 review, about 20 percent of people who get shingles also develop postherpetic neuralgia. Additionally, this condition is more likely to occur in people over the age of 50.
Shingles typically causes a painful, blistering rash. Postherpetic neuralgia is a complication that only occurs in people who have already had shingles.
Common signs and symptoms of postherpetic neuralgia include:
- severe pain that continues for more than 1 to 3 months in the same place that the shingles occurred, even after the rash goes away
- burning sensation on the skin, even from the slightest pressure
- sensitivity to touch or temperature changes
Age is a major risk factor for getting both shingles and postherpetic neuralgia. Risk begins to increase at age 50 and rises exponentially the older you get.
People who have acute pain and severe rash during shingles also have a higher risk for developing postherpetic neuralgia.
People with lowered immunity due to conditions like HIV or Hodgkin’s lymphoma have an increased risk for developing shingles. The risk of shingles is 20 to 100 greater in this group.
Most of the time, your doctor is able to make a diagnosis of postherpetic neuralgia based on how long you’ve experienced pain following shingles. Tests are unnecessary in confirming a diagnosis.
Treatment for postherpetic neuralgia aims to manage and reduce the pain until the condition goes away. Pain therapy may include the following treatments.
Pain relievers are also known as analgesics. They’re available over the counter (OTC) or by prescription.
Commonly used analgesics for postherpetic neuralgia include:
- capsaicin cream, an analgesic extracted from hot chile peppers
- lidocaine patches, a numbing medication
- OTC medications, such as acetaminophen (Tylenol) or ibuprofen (Advil)
- stronger prescription drugs, such as codeine, hydrocodone, or oxycodone
Doctors often prescribe tricyclic antidepressants to treat depression, but these medications are also effective in treating pain caused by postherpetic neuralgia.
Tricyclic antidepressants can have side effects, like dry mouth and blurred vision. They don’t act as quickly as other types of pain relievers.
Commonly used tricyclic antidepressants to treat postherpetic neuralgia include:
- amitriptyline (Elavil)
- desipramine (Norpramin)
- imipramine (Tofranil)
- nortriptyline (Pamelor)
Anticonvulsants are usually prescribed to treat seizures, but doctors can prescribe them to treat postherpetic neuralgia pain as well. Commonly used anticonvulsants include:
- carbamazepine (Tegretol)
- pregabalin (Lyrica)
- gabapentin (Neurontin)
- phenytoin (Dilantin)
Two doses of a herpes zoster vaccine called Shingrix reduce the risk of shingles by more than
Learn more about the Shingrix vaccine and its potential side effects.
Postherpetic neuralgia is treatable and preventable. Most cases disappear in 1 to 2 months. In rare cases, it can last longer than a year.
If you’re older than 50, it’s wise to get vaccinated against shingles and postherpetic neuralgia.
If you do develop postherpetic neuralgia, you have many treatment options to manage the pain. Talk with your doctor to find the best treatment for you.