Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a complication of the shingles infection. It causes persistent pain where you had a rash and blisters. The pain stays after the rash and blisters go away. The same virus that causes chickenpox can wake up later in life and cause shingles (also referred to as herpes zoster).

PHN is the most common complication of shingles. About 1 to 2 out of every 10 people who get shingles also develop this condition.

Pain can wear you down physically, mentally and emotionally. Talking with your provider is an important first step. Together, you can create a plan to help manage the pain and improve how you feel each day.

Postherpetic neuralgia symptoms

Symptoms may start while you have a shingles rash or after the rash goes away. This could be a few weeks to months later. Symptoms could include:

• Pain (aching, burning, sharp, shooting, shocking) that’s constant or comes and goes
• Itchy skin
• Loss of feeling or numbness
• Sensitive skin (to touch, pressure or temperature changes)

The pain can feel different from person to person.

Causes of postherpetic neuralgia

PHN happens when shingles damages your nerve fibers. These damaged nerves send stronger pain signals to your brain than they should. This causes ongoing pain. Doctors still don’t know exactly why some people develop this condition after shingles while others don’t.

The same virus that causes chickenpox (varicella-zoster virus) also causes shingles. After you have chickenpox, the virus stays in your body. It stays “asleep” for many years. If the virus becomes active again, it causes shingles.

Risk factors for postherpetic neuralgia

You may be at higher risk of developing PHN if you:

• Are above age 50
• Didn’t get the shingles vaccine
• Had a severe rash, symptoms near your eyes or pain with shingles
• Have diabetes
• Have a weakened immune system

PHN complications

Living with long-term pain can affect many parts of your life and health, like:

• Feeling sad or depressed
• Feeling tired all the time
• Sleeping less
• Eating less than usual
• Problems focusing or thinking clearly

If pain is making your daily life difficult, it’s important to ask for help. And you may want to talk to a mental health professional for emotional support resources.

How doctors diagnose postherpetic neuralgia

Most of the time, doctors can tell if you have PHN by:

• Checking your symptoms
• Asking about your medical history
• Doing a physical exam

If you had shingles without a rash or a rare type that affects your throat, your provider may order lab tests or imaging tests to be sure.

How is postherpetic neuralgia treated?

If you have PHN, your healthcare provider will likely start by prescribing one of these medications:

• Tricyclic antidepressants (like nortriptyline)
• Antiseizure medications (like pregabalin or gabapentin)
• Serotonin-norepinephrine reuptake inhibitors (like duloxetine)
• Sodium channel blockers (like carbamazepine or suzetrigine)
• Lidocaine cream or patch
• Capsaicin cream or patch
• Capsaicin 8% patch

Each of these medications has different side effects. They can also interact with other medications you take. Your provider will carefully review the possible side effects and risks with you.

It may take time to find a treatment that relieves symptoms. You may need to try more than one medication, or your provider may prescribe several medications at the same time. Contact your provider if your symptoms don’t improve. Take all of your medications exactly as prescribed.

For long-lasting and difficult-to-treat cases, your provider may recommend more invasive treatments for pain management, like:

• Nerve blocks
• Epidurals
• Spinal cord stimulation
• Cryoablation of intercostal nerves (less common)

What can I expect if I have postherpetic neuralgia?

While there isn’t a cure, there are treatments that can help lower how much pain you feel. Managing pain may take time. It could involve trying different treatments to find what works best for you. Some may help more than others. You’ll likely need to keep working with your provider to adjust your care as needed.

Coping with PHN takes patience. Taking care of both your body and mind can make a big difference. Talking with a mental health professional may also help you manage the emotional side of living with pain.

How long does postherpetic neuralgia last?

How long PHN lasts can be different for each person. For many, the pain lasts for months or even years. In some cases, the pain may never go away completely. But treatment options can help you manage it.

Can postherpetic neuralgia be prevented?

The best way to prevent PHN is by getting the shingles vaccine. The vaccine reduces your chances of getting shingles and the long-lasting nerve pain that can come with it. Adults usually get the vaccine in two doses, a few months apart.

There’s also a chickenpox vaccine. If you or your children have never had chickenpox, getting this vaccine may help prevent the virus from entering your body. If you never get chickenpox, you can’t get shingles or PHN later in life.