Postherpetic neuralgia

• Causes, incidence, and risk factors

  Postherpetic neuralgia occurs when the nerves have been damaged after an outbreak of shingles. Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox.

  Postherpetic neuralgia is more likely to occur in people over age 60.

• Symptoms

  The main symptom is pain in the area where shingles once occurred. The pain can range from mild to very severe. It lasts for months, sometimes years, after the original shingles infection.

• Treatment

  Anticonvulsant drugs, usually used for seizures, may help with the pain of damaged nerves. Gabapentin and pregabalin are the ones most commonly used to treat postherpetic neuralgia.

  Skin patches with lidocaine (a numbing medicine) may also be prescribed to relieve some of the pain for a period of time.

  Pain medications are often needed. Sometimes acetaminophen or NSAIDs such as ibuprofen are enough. Many patients will need stronger, prescription drugs such as codeine, hydrocodone, oxycodone.

  Drugs used to treat depression (antidepressants) may also help reduce pain, as well as help with sleep.

  Electrical nerve stimulators may be used for severe, long-term cases of postherpetic neuralgia.

  Consultation with a pain specialist may be necessary in some cases.

• References

  Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009 Mar;84(3):274-80. Review.

Review Date: 6/10/2009

Reviewed By: Reviewed by Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.