Postherpetic neuralgia (PHN) is the most common complication of shingles. If you’ve had chickenpox, you’ll always have the virus in your body. Sometimes the virus becomes active again, causing shingles followed by PHN. Vaccines can prevent both chickenpox and shingles. Pain-relieving medications can manage symptoms. For most people, PHN improves over time.
Postherpetic neuralgia (PHN) is a complication of shingles infection (also called herpes zoster). Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox.
Shingles causes a painful, blistering rash and other symptoms. The rash most commonly occurs in a band pattern on one side of your body, usually on your trunk (central core of your body). The rash turns into blisters. As the rash/blisters go away, pain may remain. When pain remains, the condition is called postherpetic neuralgia.
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You will feel pain in the area where the shingles rash developed. The pain can be constant or “come and go.” Some people describe the pain as burning, jabbing or aching. Others (less common) say the affected area feels numb or itchy.
Postherpetic neuralgia (PHN) can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.
The pain from PHN can be so severe in some people that it disrupts their life. Researchers don’t know why some people have severe or long-lasting pain and others do not.
Varicella-zoster virus causes both chickenpox and shingles. About 99% of Americans over age 40 have had chickenpox. About one in three people in the U.S. develop shingles in their lifetime. Some 10 to 18% of people who get shingles will develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles.
Factors that increase the risk of developing postherpetic neuralgia (PHN) include:
Postherpetic neuralgia (PHN) results from damage to nerve fibers during shingles infection. The nerve fibers at the skin in the affected area send exaggerated pain signals to your brain. Postherpetic neuralgia means nerve pain after herpes. Shingles is also called herpes zoster.
Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once you’ve had chickenpox, the virus remains in your body for your entire life, but is dormant or “silent” for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people (< 20%) who get shingles develop PHN.
Common postherpetic neuralgia symptoms include:
Postherpetic neuralgia (PHN) is usually diagnosed based on your symptoms, history of having shingles and physical exam. If you’ve had a recent case of shingles and have pain in the area where the shingles rash once was, you likely have PHN. Your provider may want to make sure your pain is not caused by something else, but in most cases, no other tests are needed.
Postherpetic neuralgia can cause:
Pain from long-lasting PHN can lead to depression.
If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir (Zovirax®), valacyclovir (Valtrex®) or famciclovir (Famvir®). These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed.
If your shingles outbreak is not caught early, your healthcare providers has many options to manage your postherpetic neuralgia (PHN) symptoms.
If your pain is mild, your healthcare provider may recommend:
If your pain is more severe, your healthcare may prescribe:
There’s no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. You and your provider will discuss options and what makes sense to try for you. Contact your provider if your pain is not lessening after taking your medicine. Take all your medications exactly as prescribed.
Although there is no cure for PHN, it can be treated. For most people with PHN, pain improves with time and eventually goes away. For most people, the pain goes away in one to three months.
The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. The recombinant herpes-zoster vaccine (Shingrix®) is recommended to prevent shingles in adults ages 50 and older. The vaccination is given in two doses, two to six months apart. The two-dose vaccine is 90% effective at preventing shingles and PHN. Protection lasts at least for four years after you get vaccinated.
If you have never had chickenpox or have children who have never had chickenpox, getting the chickenpox vaccine (Varivax) can help prevent getting this infection in the first place. If you never get chickenpox, you will not have the varicella-zoster virus in your body and will not get shingles or PHN.
The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if:
If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.
There’s no standard treatment for the symptoms of postherpetic pain (PHN). Depending on the severity of your pain, you may start with over-the-counter products. If your pain is more severe, one or more prescription medications may be tried. PHN is difficult to treat. Achieving a complete symptom-free state was achieved in less than half the patients with PHN, according to one study.
PHN tends to happen in older individuals who may have other health conditions, which can complicate treatment and results. Pain can last weeks, months and even longer than a year. In some people, the pain can be debilitating. In most people, PHN lessens with time.
A note from Cleveland Clinic
The best way to not get postherpetic neuralgia (PHN) is to prevent it from happening in the first place. Varicella-zoster virus causes both chickenpox and shingles. Vaccines are available to protect against developing both of these viral infections.
Once you develop chickenpox, the varicella-zoster virus remains in your body for life. If the virus reactivates and causes shingles, you have a few days around the rash outbreak to see your provider and get an antiviral medication, which can significantly lessen your symptoms. Still, if you develop PHN, your provider has many medications available to manage your symptoms.
Last reviewed by a Cleveland Clinic medical professional on 10/27/2021.
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