Postherpetic Neuralgia

Shingles is a painful skin condition that can sometimes lead to a problem called postherpetic neuralgia. This happens when the nerve pain and discomfort from shingles continue even after the rash and blisters have healed.

The chance of getting postherpetic neuralgia is higher for older adults. People over 60 are most often affected. While there's no way to completely get rid of postherpetic neuralgia, there are treatments that can help manage the pain. In many cases, the symptoms of postherpetic neuralgia improve over time.

Shingles pain often stays focused on the skin area where the initial rash appeared. This is usually a band-like shape around the torso, typically on one side of the body. The pain from postherpetic neuralgia (PHN) continues for three months or more after the shingles rash has gone away. This pain can feel different for various people. Some describe it as a burning, sharp, or stabbing sensation, while others feel a deep, aching pain.

A common symptom of PHN is extreme sensitivity to touch. Even light contact with clothing can be unbearable for those experiencing this.

Less frequently, PHN can cause itching or a loss of feeling in the affected area.

It's crucial to see a doctor at the first sign of shingles. Sometimes, the pain from PHN can start before you even notice a rash.

Taking antiviral medications within three days of getting shingles can significantly reduce the risk of developing PHN. These medications fight the virus causing shingles.

See a doctor right away if you think you might have shingles. Sometimes the pain comes before you see any skin rash. If you start taking antiviral medicine within three days of getting the shingles rash, it can lower your chances of having long-lasting nerve pain (postherpetic neuralgia). Antivirals are medications that fight the virus.

Shingles is a skin rash that's linked to inflammation in the nerves under the skin. Essentially, the nerves become irritated.

Shingles is caused by the same virus that causes chickenpox. After you've had chickenpox, the virus stays in your body. Sometimes, years later, the virus can reactivate and cause shingles. This is more likely as you get older. Treatments that weaken your immune system, such as chemotherapy for cancer, can also increase the risk of shingles.

A complication of shingles can be a condition called postherpetic neuralgia. This happens when the nerve fibers are damaged during a shingles outbreak. When these nerve fibers are damaged, they can't send normal signals from your skin to your brain. Instead, the signals get mixed up and amplified. This results in ongoing pain that can last for months or even years after the rash has healed.

Factors that increase the chance of postherpetic neuralgia (PHN) after shingles include:

• Age: Being 60 years old or older significantly raises the risk. As we get older, our bodies may heal more slowly, making PHN more likely.

• Severity of shingles: If your shingles rash was extensive and caused a lot of pain that made it hard to do everyday things, like showering or getting dressed, you have a higher risk of developing PHN. Severe cases put more stress on the nerves.

• Underlying health conditions: Having a long-term illness, like diabetes, can weaken your immune system and make it harder for your body to fight off the virus and recover from shingles. This can also lead to more nerve damage.

• Location of shingles rash: Shingles on your face or torso (chest and back) are linked to a higher risk of PHN. These areas often have a higher concentration of nerves that are more susceptible to damage.

• Delayed antiviral treatment: Starting antiviral medicine within 72 hours of the rash appearing is crucial. Delaying treatment can increase nerve damage and the risk of PHN. Antiviral medications work best when started early.

• Lack of shingles vaccination: Getting vaccinated against shingles can significantly reduce the risk of developing the condition and, if you do get shingles, can lessen its severity. The shingles vaccine helps protect your nerves from damage.

In summary, several factors can influence the likelihood of developing postherpetic neuralgia after shingles. Age, the severity of the shingles, underlying health conditions, rash location, timely antiviral treatment, and vaccination status all play a role. Knowing these risk factors can help you and your doctor take steps to reduce your chances of experiencing PHN.

People who have postherpetic neuralgia (PHN) – a condition where shingles pain continues long after the rash is gone – may experience other problems related to the persistent pain. The length and intensity of the PHN pain often determine how these secondary issues affect them. Some common problems include:

• Depression: Chronic pain, like PHN, can lead to feelings of sadness, hopelessness, and loss of interest in activities. This is because the constant discomfort and disruption to daily life can take a toll on mental well-being.

• Sleep problems: The pain associated with PHN can make it hard to fall asleep or stay asleep. This lack of quality sleep can worsen pain and fatigue, creating a cycle that's difficult to break.

• Fatigue (tiredness): The constant pain and disrupted sleep can lead to significant tiredness or fatigue. This fatigue can impact daily activities and overall quality of life.

• Changes in appetite: PHN can sometimes affect a person's appetite, making them feel less hungry than usual. This is another way the pain and stress associated with the condition can impact the body.

Shingles vaccines can protect you from getting shingles and the painful nerve pain called postherpetic neuralgia. It's a good idea to talk to your doctor about when you should get vaccinated.

In the US, the CDC (Centers for Disease Control and Prevention) recommends the Shingrix vaccine for adults 50 and older. They also recommend it for anyone 19 and older who has a weakened immune system due to illness or medical treatments. This recommendation applies even if you've already had shingles or received an older type of shingles vaccine called Zostavax.

Shingrix needs two shots, given 2 to 6 months apart. Getting both doses makes Shingrix very effective – over 90% effective at preventing shingles and the painful nerve pain that can follow.

While Shingrix is the recommended vaccine in the US, other shingles vaccines are available elsewhere. It's important to discuss other options with your doctor to understand how well they work in preventing shingles and postherpetic neuralgia in your specific situation.

Your doctor will examine your skin. They might gently feel different parts of your skin to see exactly where the problem area begins and ends.

Usually, no further tests are required.