Altered sensation, and spontaneous pain, often caused by minor stimuli following the shingles or herpes zoster, which may exist long after healing of the characteristic blisters and rash is the sign of the condition called postherpetic neuralgia or PHN. Many methods have been suggested to treat intense zoster pain, prevent postherpetic neuralgia from progressing, and relieve patients suffering from these conditions. However, only a handful of these methods have been shown to be useful and postherpetic neuralgia continues to be a source of concern as well as frustration for doctors and patients alike1.
The postherpetic neuralgia is a complication of herpes zoster, commonly termed as shingles, where the patient feels severe pain in the skin and nerves. The same virus, producing chickenpox is responsible for herpes zoster infection. The virus remains dormant in your body after causing chickenpox in the early part of your life and comes back in the later stages to cause shingles (typically when your immune system becomes compromised or weak due to age or other immune deficient conditions)2.
The postherpetic neuralgia happens when the pain accompanying shingles does not go away even when the blisters and rash associated with shingles disappear or heal. For most postherpetic neuralgia patients the condition lasts for 1 to 3 months. But on rare occasions, it may continue to bother you for more than a year2.
Is Postherpetic Neuralgia A Serious Condition?
Postherpetic neuralgia can be extremely painful and annoying, particularly when it persists for a long time. The disorder may hamper your normal lifestyle as the pain and sensitivity to touch make daily activities difficult. Simple bathing and wearing clothes may become a daunting and painful task. However, the condition is not life-threatening or fatal. It will go by itself after a certain period, which may be 1 month or more than a year, depending on your general health and immune system condition. Generally, the elder you are, the less painful is the disorder and goes away quickly as well3.
There is no direct treatment of the disease and the main purpose of different therapy is to provide relief from the pain and help to maintain normal daily life as far as possible.
The condition becomes serious when you get addicted to the pain medicines such as opioids or suffer from side effects of high dose analgesics. This typically happens if you are experiencing severe pain and discomfort during PHN and normal analgesics and low dose antidepressants fail to control it3,4.
Can Postherpetic Neuralgia Be Reversed?
Postherpetic neuralgia has a significant effect on the life of individuals affecting the functional, physical, social and psychological well-being of them. The increase in pain severity due to postherpetic neuralgia directly impacts the loss or inability to carry out daily chores of life. Although daily activities get affected in shingles as well, the effect is more prominent in the case of postherpetic neuralgia. The long duration of the condition in some individuals makes the situation even more difficult3,4.
In rare cases, the condition may lead to muscle weakness and physical impairment. Following an acute postherpetic neuralgia episode, some patients may permanently loss independent movement and related activities. Administration of antiviral drugs within 72hr of the appearance of symptoms can provide quick recovery and relief from pain. But, in most cases, patients visit doctors after this initial period when the pain becomes severe. Taking antiviral drugs after 72hr usually, offer limited efficacy. Current postherpetic neuralgia treatments are mainly inadequate and often followed by unbearable side effects. Recognition of these problems and the significant burden of postherpetic neuralgia on the normal lifestyle of patients can contribute to enhanced management and prevention of the disorder4.
Postherpetic neuralgia is a prevalent condition that can significantly decrease the functional ability and quality of life of patients. The occurrence of postherpetic neuralgia is low among young people, but for individuals over the age of 50, the chance of having postherpetic neuralgia rises sharply. Although the disease is not fatal, it is difficult to reverse the condition. Anti-viral therapy received moderate success when administered within 72hr of the onset of symptoms. Pain management is the only viable solution that may also contribute to unwanted side effects. It is better to opt for vaccination against herpes zoster after reaching the age of 50.
- Oxman M, Levin M, Johnson G, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. New England Journal of Medicine. 2005;352(22):2271-2284.
- Johnson RW, Rice AS. Postherpetic neuralgia. New England Journal of Medicine. 2014;371(16):1526-1533.
- Gan EY, Tian EAL, Tey HL. Management of herpes zoster and post-herpetic neuralgia. American journal of clinical dermatology. 2013;14(2):77-85.
- 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.