What Is Postherpetic Neuralgia
Postherpetic neuralgia is a nerve pain that persists after a shingles rash has cleared. If your pain from shingles goes but then returns at a later date, this too is called PHN.
Shingles is an infection of a nerve and causes a typical rash. It is caused by the chickenpox virus. About 1 in 5 people have shingles at some time in their lives. Shingles can occur at any age but it is most common in people aged over 50. Most people with shingles have pain but the pain usually eases soon after the rash clears. PHN is pain that persists . See the separate leaflet called Shingles for more details.
When To Seek Care
Early shingles symptoms, such as pain or flu-like feelings, are not obvious signs of a shingles outbreak.
Once a rash appears, you should see your primary care physician or a dermatologist. A trained eye can often diagnose shingles by visually inspecting the rash.
If you have shingles, you may never experience the extreme pain that can often come with it. You may only feel itching and some minor discomfort.
Even without the painful symptoms of shingles, its recommended that you see a healthcare professional and start antiviral treatment within 72 hours of a rashs appearance.
Its especially important to seek prompt medical care if a rash forms near one or both eyes. Shingles in the eye may cause permanent vision loss.
How Is Shingles Diagnosed
To diagnose shingles, your doctor will ask you about your symptoms and also do an examination. Some people may have pain with no rash or rash with no pain. In such cases, a blood test may be needed to confirm the diagnosis. See your doctor as soon as you think you may have shingles. This should be within 4872 hours of the rash first appearing, so you can be given antiviral medication to reduce the risk of complications. The earlier that antiviral medication is given, the more effective it is.;If it is a holiday period, go to an afterhours clinic.
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Characteristics Of Shingles Pain
The varicella-zoster virus lies dormant in your nerve cells after you have chickenpox. If it reactivates, the virus travels through a nerve path in your body. Common descriptions of shingles symptoms include sensitivity to touch, itching, and nerve pain.
Cases of shingles often begin with a strange, tingling sensation in your skin. Then, oozing blisters develop. You can transmit the virus to people who havent had chickenpox at this stage if they come in contact with the blisters.
Once the blisters crust over, others cant get the virus. People who have had chickenpox cant catch the virus from others, because its already in their bodies.
The blistering patches characteristic of shingles usually appear on one side of your torso, wrapping around your waist. In rare cases, the rash may develop on one side of your face. Pain and blistering may last for several weeks.
Over-the-counter medications are generally ineffective for shingles. Depending on the severity of your condition, steroid or antidepressant medication can help manage symptoms until the blisters clear up.;
What Is The Outcome For Someone Who Has Shingles
Most people get shingles once, but its possible to get it again.
If you have a healthy immune system, the blisters tend to clear in 7 to 10 days. The rash tends to go away completely within 2 to 4 weeks. The pain may last longer, but usually stops in 1 or 2 months.
For some people, the pain will last longer than the rash. When it does, its called postherpetic neuralgia , which can come and go or be constant. PHN can last for months, years, or the rest of your life. Treatment can help reduce the amount of pain you feel.
Be sure to tell your doctor if you continue to have pain. Treatment can help you feel more comfortable.
For anyone who has a shingles rash, the right self-care can help ease your discomfort. Youll find out what dermatologists recommend at, Shingles: Self-care.
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ReferencesCenters for Disease Control and Prevention . About shingles. Page last reviewed 10/17/2017. Last accessed 4/1/2019.
Dooling KL, Guo A, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. Morb Mortal Wkly Rep 2018;67:103-8.
Madkan V, Sra K, et al. Human herpes viruses. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008: 1204-8.
Straus SE, Oxman MN. Varicella and herpes zoster. In: Wolff K, Goldsmith LA, et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill Medical, New York, 2008: 1885-98.
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Management Of Herpes Zoster And Postherpetic Neuralgia
SETH JOHN STANKUS, MAJ, MC, USA, MICHAEL DLUGOPOLSKI, MAJ, MC, USA, and DEBORAH PACKER, MAJ, MC, USA, Eisenhower Army Medical Center, Fort Gordon, Georgia
Am Fam Physician.;2000;Apr;15;61:2437-2444.
;Patient information: See related handout on shingles, written by the authors of this article.
Herpes zoster results from reactivation of the varicella-zoster virus. Unlike varicella , herpes zoster is a sporadic disease with an estimated lifetime incidence of 10 to 20 percent. The incidence of herpes zoster increases sharply with advancing age, roughly doubling in each decade past the age of 50 years. Herpes zoster is uncommon in persons less than 15 years old. In a recent study,1 patients more than 55 years of age accounted for more than 30 percent of herpes zoster cases despite representing only 8 percent of the study population. In this same study, children less than 14 years old represented only 5 percent of herpes zoster cases.
The normal age-related decrease in cell-mediated immunity is thought to account for the increased incidence of varicella-zoster virus reactivation. Patients with disease states that affect cell-mediated immunity, such as human immunodeficiency virus infection and certain malignancies, are also at increased risk. Chronic corticosteroid use, chemotherapy and radiation therapy may increase the risk of developing herpes zoster.
Why Does The Pain Persist In Some People
The symptoms of PHN can last for several months in some people. Shingles causes inflammation of the nerve. Pain can be expected whilst the rash and inflammation occur. However, it is not clear why some people continue to have pain when the inflammation has gone. It is thought that some scar tissue next to the nerve, or in the nearby part of the spinal cord, may be a factor. This may cause pain messages to be sent to the brain.
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Pain Management For Postherpetic Neuralgia
Postherpetic neuralgia is a complication of shingles, which is caused by the chickenpox virus. The condition affects nerve fibers and skin, causing a burning pain that lasts long after the rash and blisters of shingles disappear. There is no known cure for postherpetic neuralgia, but the pain management experts at Novus Spine & Pain in Lakeland, Florida can help you manage the pain.
Reducing Pain And Itching
- 1Try to keep from scratching at your blisters. As difficult as it may be, leave your blisters alone and avoid scratching. They will crust over and then fall off on their own. If you scratch them, they will open up and become more susceptible to infection.
- You will also spread bacteria with your hands if you scratch at the blisters. If this does happen inadvertently, always wash your hands afterward to stay hygienic.
- 2Use a baking soda paste to reduce irritation. Baking soda has a pH greater than 7 , giving it the ability to neutralize the chemical that creates the itching sensation. The chemical creating the itching sensation is acidic with a pH that is less than 7.
- Apply a paste made of 3 teaspoons baking soda mixed with 1 teaspoon of water. This relieves itching and helps the blisters dry out quicker.
- You can apply this paste as often as needed to relieve the itching.
- 3Apply a cold compress to your blisters. Use a cool, moist compress to ease discomfort. You can apply this compress for up to 20 minutes at a time, several times a day.
- You can make a cold compress by wrapping an ice block in a clean towel and pressing it against your skin. Alternatively, you can use a bag of frozen vegetables. Just make sure not to put it directly on your skin and not to keep it on your skin for more than 20 minutes at a time as both of these conditions can lead to tissue damage.
-
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Study Explains Why Patients With Shingles Feel Pain
by FAPESP
In most cases, chickenpox is a benign childhood infection with symptoms that disappear within 10 days. However, the Varicella zoster virus that causes it remains dormant in the patient forever. In some cases, the virus can be reactivated years later, causing a different disease known as herpes zoster, or shingles.
One of the first and most unpleasant symptoms of shingles is neuralgia, or constant intense pain affecting mainly the nerves of the chest and neck, the trigeminal nerve in the face, and the lower back. The pain may be accompanied by paresthesia, a feeling of pins and needles, tingling, prickling, itching, numbness, burning and/or cold). A painful blistering skin rash often develops.
Researchers affiliated with the University of São Paulo have published a study in The Journal of Neuroscience describing how the immune mechanisms triggered by the reactivated virus change the way that sensory neurons work. The authors say that their discoveries lay a foundation for novel treatments not only to combat acute pain but also to prevent it from becoming chronic, a condition known as post-herpetic neuralgia.
Almost all adult humans carry VZV, he added. VZV usually lies dormant in the ganglia, clusters of sensory neurons that project to different parts of the body. An unexplained decrease in immunity leads to VZV reactivation in some people, causing inflammation of the ganglia. Shingles usually affects people over 60.
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For Some Pain From Shingles May Linger And Become Long
Dear Mayo Clinic:
I have been diagnosed with shingles of the trigeminal nerve affecting my face. How do I reduce the pain in my head and eye after having shingles?
Answer:For most people, the pain from a case of shingles usually fades as the rash disappears. But for some, the pain may linger and become a long-term condition. A variety of treatments may lessen this pain, but the condition can be challenging to treat.
Shingles is a localized form of chickenpox. Once you’ve had chickenpox, the varicella-zoster 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.
Shingles typically involves a bandlike rash on the chest, abdomen or face that is usually quite painful. Most people recover from shingles in a few weeks without other problems, but a small number continue to have severe pain in the same distribution that was irritated when the virus returned. Pain that lasts for three months or more is called postherpetic neuralgia.
If medications aren’t enough, procedures such as nerve blocks or steroid injections may help lessen postherpetic neuralgia.
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See Your Pharmacist Or Medical Professional
- see your doctor as soon as possible if you think you have shingles
- early treatment with antiviral tablets can reduce symptoms and complications, which is especially important if the rash is on your face, neck or scalp. The complications from shingles here can be more serious, including damage to your sight
- see your doctor again if the pain does not go away after initial treatment, particularly if it is interfering with your sleep or making you feel depressed
- see your doctor if the rash is not healing, especially if there is swelling or pus; sometimes the rash can become infected with bacteria
Ways To Deal With Shingles Nerve Pain
Shingles is a common disease that affects people above the age of 50 years. The virus that causes chickenpox when you are young instigates shingles. While there are many issues that might develop when you have shingles, one of the most common problems that old people face in this duration is nerve damage in the affected area. Usually, the pain goes away when the rashes and redness fade with time. Here are five simple ways to deal with shingles nerve pain.
Healing bathsShingles nerve pain is caused because of the blisters on the skin. One of the most common ways of dealing with it is to give healing baths on the affected area. Taking a cool water shower will ease the pain, and calm down the itchiness as well as the redness on the skin. You can also add cornstarch into warm water and soak the affected area for 20 minutes before cleaning it off with a soft cloth.
Cool compressIf you use a cold compress on your affected area of shingles nerve pain, it will give you a lot of relief. If you do this more than five times a day, you will feel instant pain relief in the area. However, it is suggested that you should refrain from using an ice pack in this area. This kind of cold feeling can make the skin so sensitive that it will worsen the pain.
Dietary changesIf you are suffering from shingles, then you must include foods rich in vitamin A, B, C, and E in your diet.
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What Can I Do For The Pain
Not everyone has the same amount of pain from shingles. Over-the-counter pain medicine like acetaminophen and ibuprofen can help ease the pain. A liquid medicine that you put on your skin can help cool the rash and stop the itching. Your doctor can give you pain medicine if your rash hurts a lot.
Sometimes the pain does not go away with the rash. This is called postherpetic neuralgia .
How Long Does Shingles Last
Most cases of shingles last three to five weeks. Shingles follows a pattern:
- The first sign is often burning or tingling pain; sometimes, it includes numbness or itching on one side of the body.
- Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
- A few days later, the rash will turn into fluid-filled blisters.
- About a week to 10 days after that, the blisters dry up and crust over.
- A couple of weeks later, the scabs clear up.
Most people get shingles only one time. But, it is possible to have it more than once.
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Is It Possible To Prevent Postherpetic Neuralgia
Zostavax, the herpes zoster vaccine , has been shown to significantly decrease the risk of shingles. The vaccine is approved by the Food and Drug Administration for adults age 50 and older, and is recommended for all adults 60 and older who arent allergic to the vaccine and who dont take immune-suppressing medications.
People age 50 to 59 may want to talk to their doctor about the shingles vaccine, if they are having ongoing pain or skin issues or have a weakened;immune system. The vaccination is not a guarantee that shingles will not occur; however, those who get the vaccine usually experience a shorter period of pain.
The Empowered Patient’s Guide To Postherpetic Neuralgia
New treatment for the pain of shinglesBeing vaccinated against shingles is the best way to prevent postherpetic neuralgia , lingering pain from the shingles virus. Here’s what you should know about the causes, symptoms, and treatments for this painful chronic condition.
Postherpetic neuralgia , also known as shingles, most commonly occurs as a rash on one side of the torso.
This is no ordinary rash but the ithcy blisters aren’t even the worst part.;A painful condition known as postherpetic neuralgia is the horrible gift that keeps on giving for more than 10% of people who develop it following a bout of shingles.
Oh yeah and the pain? It can be significant. People familiar with the burning, relentless feeling of PHN have likened it to passing a kidney stone; mothers have described it as pain “worse than labor”.
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Have A Rash Go To The Doctor
If you think you might have shingles, talk to your doctor as soon as possible. Its important to see your doctor no later than three days after the rash starts. The doctor will confirm whether or not you have shingles and can make a treatment plan. If you have a condition that weakens the immune system, the doctor may give you a shingles test. The shingles test can also help doctors diagnose shingles in people who don’t have a rash. Although there is no cure for shingles, early treatment with drugs that fight the virus can help the blisters dry up faster and limit severe pain. Shingles can often be treated at home. People with shingles rarely need to stay in a hospital.
How Long Does Postherpetic Neuralgia Last And How To Treat It
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Postherpetic neuralgia is a chronic complication of herpes zoster , which affects the nerves. Herpes zoster results from reactivation of dormant viruses in the sensory ganglion and is manifested by acute, painful vesicular rash over a single dermatome . The varicella-zoster virus is a nerve virus that gains access to neurons during a childhood infection of chickenpox . More than 95% of young adults are seropositive for VZV, and the incidence rate is 3.4 cases per 1,000 persons.
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