Dennis J. Bonner, MD

Postherpetic Neuralgia

Postherpetic Neuralgia

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Background Of Postherpetic Neuralgia:

Herpes zoster (HZ) is a viral disorder, often manifesting as chickenpox. Human herpesvirus-3 (HHV-3) is also known as the varicella-zoster virus (VZV). Following the acute phase, the virus reaches the sensory nerve system, which resides in the geniculate, trigeminal, or dorsal root ganglia for many years. The virus reactivates with age or immunocompromised individuals, resulting in an eruption (shingles). Discomfort can continue or reoccur even after the acute rash has faded in shingles-affected areas. Postherpetic neuralgia is the medical term for this ailment (PHN).

What Is Postherpetic Neuralgia, And How Does It Affect You?

The nerves and skin are affected by postherpetic neuralgia, which is a painful disorder. It's a side effect of herpes zoster, also known as shingles. Shingles is a distressing, blistering skin rash caused by the varicella-zoster virus reactivating.

Chickenpox is the most common way to catch this virus during childhood or adolescence. After childhood, the virus can remain dormant in the body's nerve cells and be reawaken decades later

Postherpetic neuralgia is a disorder that occurs when the pain produced by shingles does not go away after the rash and blisters have healed. The most common shingles consequence is postherpetic neuralgia. It happens when shingles damage the nerves.

Because the injured nerves cannot transmit messages from the skin to the brain, the messages become jumbled. This causes continuous, excruciating pain that can last months. As per a 2021 study, roughly 20% of shingles patients also experience postherpetic neuralgia. Furthermore, those over 50 are more likely to have this illness.

What Are The Signs And Symptoms Of Postherpetic Neuralgia?

Symptoms of shingles include fever, chills, exhaustion, and a headache, which are all typical of a viral infection.

On the other hand, shingles are primarily characterized by a painful rash. This frequently occurs because of:

  • Frequently as a stripe on one side of the body, the waist, back, abdomen, or chest

  • The ears, eyes, and mouth are all part of the face.

  • Internal organs, such as those in the gastrointestinal tract or the brain's arteries

When shingles strike, a person usually feels a tingling, burning, or numb sensation on their skin, usually on one side of their body. Clusters of small, fluid-filled blisters occur after a few days, occasionally accompanied by reddish skin. The blisters start to dry up after 7–10 days, and the symptoms normally go away after 2–4 weeks.

Risk Factors

Both shingles and postherpetic neuralgia are linked to increasing age. Risk begins to climb at the age of 50 and continues to rise exponentially as you become older.

Those with acute pain and a significant rash during shingles are more likely to develop postherpetic neuralgia.

People with lessened immunity, such as those with HIV or Hodgkin's lymphoma, are more conceivable to acquire shingles. In this group, the risk of shingles is 20 to 100 times higher.

Some problems from shingles might be severe, long-lasting, or both. There are also the following challenges:

  • If the rash materializes in or near an eye, it might cause visual loss.

  • If the rash is in or around an ear, it might cause hearing and balance issues.

  • Muscle wasting

  • Paralysis of the face

  • Pneumonia

  • Encephalitis is a type of brain inflammation.

  • Stroke

Postherpetic neuralgia (PHN) is another consequence that affects 10–18 percent of persons who have had shingles.

After the rash has driven away, a person with PHN experiences persistent pain in the rash region. The agony can be excruciating, and it can persist for years.

Who Is Afflicted With Postherpetic Neuralgia?

After shingles, about 1 in every five people will experience these severe, persistent aches. However, there are a few things that can improve your chances of obtaining it:

  • Age: Most persons who get postherpetic neuralgia are over 60 years old.

  • Gender: Women appear to be more affected than males.

  • Early symptoms: People who experience numbness, tingling, or itching before a shingles rash forms are more likely to experience lasting pain afterward.

  • Pain in the start: If you experienced extreme pain or a rash at the outset of your outbreak, you're more likely to develop neuralgia later.

  • Other health issues: People with chronic illnesses that impair the immune system, such as HIV and cancer, appear more likely to contract it.

When Should You See A Doctor?

At the first indication of shingles, see a doctor. Often, the pain begins before the rash appears. Also, if you start taking antiviral drugs within 72 hours of getting shingles, your chances of having postherpetic neuralgia are reduced.

Consequences:

People with postherpetic neuralgia may develop various symptoms associated with chronic pain, depending on how long it lasts and how painful it is.

  • Depression

  • Fatigue

  • Sleeping problems and a lack of appetite

  • Concentration problems

What Are The Symptoms And Treatments For Postherpetic Neuralgia?

The most common method for diagnosing shingles is examining the rash and asking about the symptoms. Your doctor can often diagnose postherpetic neuralgia based on how long you've been in pain after shingles. Tests aren't required to confirm a diagnosis.

Shingles cannot be cured or the virus removed from the body. On the other hand, antiviral drugs can help manage symptoms, decrease the length of illness, and lower the risk of consequences.

Postherpetic neuralgia drug treatment aims to control and minimize pain until the condition goes away. The following treatments may be used in pain management.

Anticonvulsants:
Anticonvulsants are typically used to treat seizures, but they can also relieve pain from postherpetic neuralgia. 

Analgesics:

Analgesics are a type of pain medication. They're available without a prescription or over-the-counter (OTC). Analgesics commonly used for postherpetic neuralgia include:

  • Capsaicin cream is a pain reliever made from spicy chili peppers.

  • Numbing medication lidocaine patches

  • Medications like acetaminophen (Tylenol) and ibuprofen (Advil) are available over the counter (Advil)

  • Codeine, hydrocodone, and oxycodone are stronger prescription medications.

Tricyclic antidepressants (TCAs):

Tricyclic antidepressants are commonly prescribed to treat dismay, but they are also beneficial in relieving pain caused by postherpetic neuralgia.

Side outcomes of tricyclic antidepressants include dry mugs and impaired eyesight. In addition, they take longer to work than other types of pain medications.

Tricyclic antidepressants are commonly used to treat postherpetic neuralgia.

  • Amitriptyline (Elavil)

  • Desipramine (Norpramin)

  • Imipramine (Tofranil)

  • Nortriptyline (Pamelor)

How Much Do Treatments For Postherpetic Neuralgia Cost?

For patients covered by healthiness insurance, out-of-pocket costs normally consist of doctor visit copays, prescription drug copays of about $5-$50 or more, plus less than $20 for over-the-counter medications. In addition, insurance usually covers the cost of shingles treatment.

Patients without health insurance can expect to pay less than $20 for over-the-counter pain relievers and antibiotic ointment, as well as $30 to $550 for prescription antiviral medication. The price of a medicine is determined by its nature and whether it is generic or brand name.

For example, the 35-50 800 mg generic acyclovir pills commonly given for shingles cost around $30-$40. t also costs around $390-$560 for the same amount of Zovirax, the brand-name counterpart.

The 21, one-gram pills of generic valacyclovir commonly prescribed for shingles cost over $240. It costs nearly $260 for the same amount of Valtrex as the brand-name equivalent. And the 2,1 500-mg famciclovir pills routinely prescribed for shingles cost over $230. Famvir, the brand-name equivalent, costs almost $320 for the same amount.

Vaccination
According to a reliable source, at 12–15 months and 4–6 years.

Teenagers and adults aged 13 and up who have never had chickenpox or the vaccine should obtain two doses at least 28 days apart if they request vaccination.

The chickenpox vaccine is not recommended for certain persons, including pregnant women and those who have moderate or severe diseases.

Adults who are 50 years or more senior and have had chickenpox or are unsure if they have had it can get a shingles vaccine.

People who match these conditions can get the shingles vaccine, regardless of whether they've had shingles before. Nonetheless, the vaccine should not be given to anyone presently suffering from shingles.

Shingrix is the vaccine's name in the United States. At least 90% protection against shingles and PHN is provided by two doses given 2–6 months apart.

Takeaway:

Shingles do not spread from one person to another. However, the underlying virus, which originally causes chickenpox, can be transmitted through shingles blisters.

After coming into touch with this fluid, anyone who has never had chickenpox or received the vaccine may acquire chickenpox and, later, shingles.

Because the same virus causes chickenpox and shingles, anyone who has had chickenpox can acquire shingles. In addition, individuals with compromised immune systems are more susceptible to shingles and associated complications.

The greatest approach to lower the risk of chickenpox and shingles is to get the varicella vaccine when you're a kid.

From the age of 50, older persons who have already had chickenpox should consider getting vaccinated against herpes zoster. This diminishes your chances of getting shingles and their complications.

Postherpetic neuralgia can be treated and avoided. Many cases go away in 1 to 2 months. However, it may persist longer than a year in some occurrences.

You can talk to your doctor to find the best course of action to relieve the pain caused by this condition.