Postherpetic neuralgia is a painful complication that can arise after suffering from shingles (also known as herpes zoster). Unlike the temporary pain associated with the rash, postherpetic neuralgia persists even after the blisters and swelling disappear.
Symptoms
The pain may be intense, sharp, acute or burning. It is often described as a deep, constant pain, which can be made worse by the touch of clothing or even a light breeze. In addition to pain, some people experience extreme tenderness, itching or loss of sensation in the affected area.
Causes
Postherpetic neuralgia is caused by reactivation of the chickenpox virus. Often, the person is infected in childhood and the virus escapes immunity after lodging in the nerve ganglia of the spine or head. The specific immunity that attacks such a virus is mediated by cells, which cannot kill the virus hiding there. When the immune cells against the virus diminish, it reactivates, attacking the nerves in which it is lodged, producing pain and a new rash, which is now located in the distribution of the affected nerve, resembling the shape of a snake. Hence the colloquial name “shingles”. This damage can cause persistent inflammation and impaired transmission of nerve impulses, resulting in severe pain that can be prolonged. Without treatment, this pain may be permanent.
Treatment
It is very important that the person affected by shingles or herpes zoster receive care from a pain management specialist as soon as possible. The best results are obtained when care is achieved in the first two weeks of involvement. As more time passes, the treatment required to control the disease tends to become more complex and the results are less effective. Multiple treatments can help relieve pain and improve patients’ quality of life. These include:
- Medications: Analgesics, anticonvulsants and antidepressants can be effective in controlling pain. Your pain specialist can tell you which ones are best for your case.
- Topical creams: Usually these medications are not effective for the control of herpes zoster, but they could help to improve some bacterial superinfections that would worsen the clinical picture.
- Anesthetic patches: May relieve symptoms of burning pain in some patients.
- Physical therapy: Specific exercises can help reduce sensitivity and improve mobility.
- Nerve blocks: In severe cases and in high-risk patients, injections of local anesthetics and anti-inflammatory drugs can be used to relieve the irritation of the affected nerve, improving symptoms.
- Radiofrequency neurolysis: In cases of permanent pain, the way the affected nerve functions may be affected, decreasing for months or years the way in which pain nerve impulses are sent to the brain.
- Hyperbaric oxygenation: In selected patients it can accelerate the speed of recovery of the clinical picture and decrease the irritation in the neuronal ganglion of the nerve root affected by the disease.
- Spinal cord neurostimulation: In the most complex cases, restoration of the injured nerve cannot be achieved. In these patients, an electrode connected to a computerized electrical impulse system must be implanted, which stabilizes the pain signals before they reach the site where they are processed in the brain. This is a surgical procedure that is reserved for selected cases in which more conservative treatments have not worked.
It is important to seek early medical attention if you experience symptoms of postherpetic neuralgia. Early diagnosis and treatment can help reduce the duration and intensity of pain.
