From the Guidelines
Postherpetic neuralgia presents as persistent pain that continues after a herpes zoster (shingles) rash has healed, typically lasting more than 3 months after the initial outbreak. The pain is often described as burning, stabbing, or shooting and occurs in the same dermatomal distribution as the original rash, as noted in a study published in the Clinical Infectious Diseases journal 1. Patients may also experience allodynia (pain from normally non-painful stimuli like light touch or clothing), hyperalgesia (increased sensitivity to painful stimuli), and paresthesias (abnormal sensations like tingling or numbness).
Key Characteristics of Postherpetic Neuralgia
- The condition most commonly affects the thoracic dermatomes, followed by trigeminal, cervical, and lumbar regions.
- Risk factors include older age (especially over 60), greater acute pain during the initial shingles outbreak, extensive rash, and immunocompromised status.
- The underlying mechanism involves nerve damage during the acute herpes zoster infection, leading to altered pain processing in both peripheral and central nervous systems, as discussed in a study published in the British Journal of Anaesthesia 1.
Impact on Quality of Life
This neuropathic pain can significantly impact quality of life, causing:
- Sleep disturbances
- Anxiety
- Depression
- Reduced daily functioning Early antiviral treatment during acute herpes zoster can reduce the risk of developing postherpetic neuralgia, highlighting the importance of prompt medical intervention 1.
From the Research
Presentation of Postherpetic Neuralgia
Postherpetic neuralgia (PHN) is a condition characterized by:
- Constant or intermittent burning, stabbing, or sharp shooting pain 2
- Hyperalgesia or allodynia, persisting beyond the healing of herpetic skin lesions 2
- Pain that can severely affect a patient's quality of life, quality of sleep, and ability to participate in activities of daily living 3
Symptoms and Characteristics
The symptoms of PHN include:
- Decreased quality of life and interference with activities of daily living 4
- Neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash 4
- Damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation 4
Treatment and Management
The treatment of PHN includes:
- Preventing herpes zoster through vaccination and/or antiviral treatment 4
- Administering specific medications to treat pain, such as calcium channel α2-δ ligands (gabapentin and pregabalin), tricyclic antidepressants, or topical lidocaine patches 4
- Interventional therapies, such as transcutaneous electrical nerve stimulation, local botulinum toxin A, cobalamin, and triamcinolone injection, stellate ganglion block, dorsal root ganglion destruction, and pulsed radiofrequency therapy 3