How To Diagnose Postherpetic Neuralgia & What Is The Best Medicine For It?

Postherpetic neuralgia (PHN) is a complication of herpes zoster. The condition is painful that impacts the skin and nerves. It is frequently referred to as shingles, which is a blistering, painful rash on your skin. It is triggered by a varicella-zoster virus reactivation that individuals generally get as the chicken pox in their infancy or adolescence. After childhood infection, the virus may lie dormant in the nerve cells of your body and may get reactivated decades later1.

The disease is called postherpetic neuralgia when the pain induced by shingles never fades away even when there are no signs of blisters and rash. It is one of the most prevalent complications associated with shingles and takes place when the shingles infection damages your nerves. The nerves which are damaged due to infection fail to transmit signals from your skin to your brain. The signals get confused, leading to extreme chronic pain which may persist for months or even years1.

How To Diagnose Postherpetic Neuralgia?

How To Diagnose Postherpetic Neuralgia?

Once you are experiencing the typical symptoms of postherpetic neuralgia, such as severe pain following shingles even after the disappearance of the blisters or rash; sensitivity to touch or burning sensation when touched (the affected area of your skin); and sensitivity to change in temperature, seek medical advice immediately2.

For both postherpetic neuralgia and shingles, age poses a significant risk factor. People over the age of 60 are at enhanced risk, and individuals over the age of 70 are at even more risk. Individuals with severe pain and serious rash at the time of shingles also have an increased danger of acquiring postherpetic neuralgia. Individuals with reduced immunity owing to illnesses such as Hodgkin’s lymphoma and HIV infection are at higher risk of having shingles in later stages of life. People with HIV infection are 15 times more prone to shingles than healthy individuals2.

No tests are required for the diagnosis of postherpetic neuralgia. The length of pain related to shingles and other physical symptoms is enough for your physician to diagnose postherpetic neuralgia.

What Is The Best Medicine For It?

Postherpetic neuralgia treatment attempts at controlling and reducing pain until the disease heals by itself. Some of the common medicinal approaches to control pain are3:

Use Of Analgesics: Analgesics are common pain killer medicines are administered in postherpetic neuralgia to control the severe pain associated with the disease. The analgesics usually prescribed in postherpetic neuralgia are capsaicin ointment (obtained from the chili pepper); other prescribed and over-the-counter pain relievers; and numbing medications such as lidocaine patches.

Use Of Anticonvulsants: These medicines are usually used to treat seizures, but different clinical examinations revealed that reduced doses of anticonvulsants can also be useful in postherpetic neuralgia pain treatment. Some of the common anticonvulsants include phenytoin, gabapentin, pregabalin, and carbamazepine.

Use Of Antidepressants: Tricyclic antidepressant medicines are usually given for the treatment of depression but are also efficient in controlling postherpetic neuralgia pain. However, these medicines have some side effects, such as blurred vision and dry mouth. Their action is also slow compared to the analgesics. Some of the most used antidepressants in postherpetic neuralgia are nortriptyline, imipramine, desipramine, and amitriptyline.

Use Of Vaccines To Prevent The Disease: A vaccine known as Zostavax that acts against herpes zoster decreases 50% of the threat of shingles as well as provides protection against postherpetic neuralgia. It is suggested that individuals reaching the age of 60 should receive the vaccine unless he or she is suffering from a compromised immune system. Weak immunity may trigger the disease as the vaccines have a live virus.

Conclusion

Postherpetic neuralgia can be prevented and treated effectively by controlling the pain. Most of the symptoms of postherpetic neuralgia go away within 1-2 months in the majority of the cases. But, there are instances of symptoms persisting for more than a year in some individuals. Once you are over 60 years of age, it is sensible to take a vaccine to prevent postherpetic neuralgia. If you are already suffering from it, try to take enough analgesics to control the pain. Try to have antidepressants if the pain is becoming too severe. It usually takes a while to heal completely and patience is needed for successful management of the condition.

References:  

  1. Johnson RW. Herpes zoster and postherpetic neuralgia. Expert review of vaccines. 2010;9(sup3):21-26.
  2. Drolet M, Brisson M, Schmader KE, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. Cmaj. 2010;182(16):1731-1736.
  3. Jeon YH. Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment. The Korean journal of pain. 2015;28(3):177.

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