What are the symptoms of postherpetic neuralgia (PHN)?

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From the Guidelines

Postherpetic neuralgia (PHN) symptoms include burning, tingling, itchy, tender, and sharp pain.

Characteristics of PHN

  • The pain is typically continuous and moderate to severe in intensity 1
  • It occurs at the site of herpes zoster and can be aggravated by light touch or eating 1
  • Allodynia (pain from non-painful stimuli) and hyperalgesia (increased sensitivity to pain) are common associated factors 1
  • The pain can be burning, stinging, or aching in nature, and may be accompanied by photophobia and wind hyperalgesia in some cases 1

Diagnosis and Treatment

  • Diagnosis is often based on a thorough examination and assessment of symptoms, as well as the use of questionnaires such as the Neuropathic Pain Symptom Inventory (NPSI)-Eye or the Ocular Pain Assessment Survey (OPAS) 1
  • Treatment options include neuropathic pain medications such as gabapentin, pregabalin, and tricyclic antidepressants, as well as topical therapies like lidocaine patches and capsaicin 1
  • In some cases, intrathecal therapy with lidocaine and methylprednisolone may be effective in providing long-lasting analgesia 1

From the Research

Symptoms of Postherpetic Neuralgia (PHN)

  • Persistent pain following the resolution of a herpes zoster rash 2, 3, 4, 5, 6
  • Constant, intermittent, or stimulus-evoked pain 3, 5
  • Burning, stabbing, or sharp shooting pain with hyperalgesia or allodynia 6
  • Steady, aching, boring pain and paroxysmal lancinating pain, usually exacerbated by contact with the involved skin 5
  • Pain can persist for months or even years after resolution of the HZ mucocutaneous eruptions 4

Characteristics of PHN

  • Affects a significant proportion of HZ patients, with the elderly being most frequently and seriously affected 3
  • Can have a severe impact on the patient's quality of life and functional ability 3
  • Highly resistant to current treatments 3
  • Can induce psychosocial dysfunction and negatively impact quality of life 4

Types of Pain Experienced by PHN Patients

  • Constant pain 3, 5
  • Intermittent pain 3, 5
  • Stimulus-evoked pain 3
  • Paroxysmal lancinating pain 5
  • Burning, stabbing, or sharp shooting pain 6

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Postherpetic neuralgia in the elderly.

International journal of clinical practice, 2009

Research

Postherpetic Neuralgia and Trigeminal Neuralgia.

Pain research and treatment, 2017

Research

Postherpetic neuralgia: the never-ending challenge.

Pain practice : the official journal of World Institute of Pain, 2005

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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