Postherpetic neuralgia is a severe chronic neuropathic pain that can linger after a shingles infection. Shingles is caused when the chicken pox virus (varicella zoster) reactivates. This virus lives dormant in nerve cells. When it becomes reactivated, it causes extreme nerve pain. This is usually manifested with symptoms consistent with pain that travels in a very discreet pattern across the body starting in the spine and radiating outward. A skin rash resembling chicken pox usually appears within a few days after the onset of pain.

People who have been infected by chicken pox are at risk for developing shingles. The shingles vaccine is the best way to prevent shingles and postherpetic neuralgia. Patients are eligible for the vaccine starting at age 50. Ask your primary care provider about getting vaccinated.

Treatment of acute shingles is extremely important in reducing chances of acute shingles transitioning to postherpetic neuralgia. There are several treatment options, but the key is early prevention. Treatments can include anti-viral medications, nerve pain medications, oral steroids, and opioids, depending on severity of symptoms. Typically, the rash revolves within two weeks, but pain may linger much longer. When medications alone do not offer sufficient pain relief, injections targeting the distribution of nerve pain can also be very effective.

Nerve pain extending three months after the onset of acute shingles is called postherpetic neuralgia. Medication options include long-term antiviral therapy, nerve pain medications, some specific antidepressants with activity for nerve pain, and oral steroids. Injected steroids can also be helpful for postherpetic neuralgia, specifically epidural steroid injections, specific nerve blocks, and sometimes, sympathetic nerve blocks. Ultimately, when more conservative treatment options fail to provide sufficient pain relief, implantable devices may be considered. Depending on the area affected, options may include a peripheral nerve stimulator, a spinal cord stimulator, or intrathecal pump.

Over the last several months, we have observed an increase in both shingles and postherpetic neuralgia compared to previous years. While the CDC has not made any formal comments on this local trend, I have reached out to colleagues nationwide who have also seen a similar trend. We’re not sure why this is the case, but potential stress to the immune system from either the vaccine or new stress from the pandemic may be contributors. At this time, there is no scientific evidence that there is a connection.

To learn more about postherpetic neuralgia and treatment options, call our office to schedule an appointment.