From the Guidelines
Postherpetic neuralgia typically lasts for more than 3 months after the initial shingles rash has healed, though it can persist for years in some cases. The duration of postherpetic neuralgia varies significantly between individuals, with factors such as age, severity of acute shingles pain, and extent of the rash influencing the likelihood of prolonged pain 1.
Key Factors Influencing Duration
- Older adults, particularly those over 60, are at higher risk for prolonged postherpetic neuralgia
- Those who had severe acute shingles pain are more likely to experience longer-lasting postherpetic neuralgia
- Individuals with extensive rash are also at higher risk for prolonged pain
Management Options
- Medications such as gabapentin, pregabalin, tricyclic antidepressants, and topical treatments like lidocaine or capsaicin patches may be used to manage postherpetic neuralgia 1
- Early antiviral treatment during acute shingles, within 72 hours of rash onset, with medications like acyclovir, valacyclovir, or famciclovir, can reduce the risk and potentially the duration of postherpetic neuralgia
Prognosis
- Most patients experience improvement within 1 year, but approximately 5-10% of patients may have pain lasting beyond 1 year
- The pain occurs because the varicella-zoster virus damages nerve fibers during the shingles outbreak, causing them to send confused, exaggerated pain signals to the brain even after the rash heals 1
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Duration of Postherpetic Neuralgia
- Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that persists 3 months or more following an outbreak of shingles 2, 3.
- The duration of PHN can vary, but it is defined as pain that lasts more than 3 months after the rash has healed 2, 3.
- Some studies suggest that PHN can last for several months or even years, with significant impairment in quality of life 4, 5.
Treatment and Management
- The treatment of PHN may include a variety of medications, such as alpha-2 delta ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, doxepin), and topical analgesics (5% lidocaine patch, capsaicin) 2, 4, 5, 6.
- The choice of treatment depends on the individual patient's response and the severity of their symptoms 2, 4, 5, 6.
- Studies have shown that pregabalin and gabapentin are effective in reducing pain and improving quality of life in patients with PHN 5, 6.
Definition and Diagnosis
- PHN is defined as pain that persists more than 3 months after the rash has healed 2, 3.
- The diagnosis of PHN is usually made clinically on the basis of the characteristic appearance of the rash and the presence of persistent pain 3.
- Early recognition and treatment of shingles can reduce the risk of developing PHN 3.