Herpes and Nerve Pain

Three of the eight human herpes viruses (HHV) become latent in nerve cells after initial infection. These include HHV-1 (cold sores), HHV-2 (genital herpes) and HHV-3 (chickenpox and shingles). Upon flare-up, these conditions lead to a recurrence of nerve pain, including during prodrome, symptoms that occur before the outbreak. The pain of herpetic conditions can be limited to outbreak or can be a lasting complication.

HHV-1

• HHV-1, also known as HSV-1 (herpes simplex virus-1), is the virus that causes most cases of oral herpes, also known as cold sores; it also causes some cases of genital herpes. The prodrome (initial) symptoms of cold sores include a tingling, burning or painful sensation in the area that will be affected. Pain may persist after the rash and blisters develop, according to the Mayo Clinic.

HHV-2

• HHV-2 (HSV-2) is the virus that leads to most cases of genital herpes, although it can also sometimes lead to a case of oral herpes. Like cold sores, the prodrome of genital herpes can cause a painful, burning or tingling sensation in the area of skin that will be affected, and the blisters themselves may be painful.

HHV-3

• HHV-3, also known as varicella-zoster virus (VZV) causes chickenpox and, upon recurrence, shingles. Shingles prodrome is a painful feeling that can be quite severe and which follows the path of the nerve in which VZV has again become active; this generally occurs on only one side of the body, normally on the buttocks or trunk of the body, but sometimes also affecting the face. The pain of shingles lasts during the outbreak of red rash with blisters, according to the Mayo Clinic.

Postherpetic Neuralgia

• For some people, the pain of shingles lasts even after the rash and blisters have cleared up. This is a condition known as postherpetic neuralgia, and the pain can be very severe and last for a number of months or even years.

Treatment

• The same class of antiviral drugs, including acyclovir, valacyclovir and famciclovir are used to treat these viruses. This treatment is most effective when begun during prodrome.

  According to the Mayo Clinic, topical agents like benzyl alcohol and lidocaine, as well as over-the-counter painkillers are used in managing the pain of cold sores. Corticosteroids and painkillers, either OTC or prescription, are used in addition to topical lidocaine and capsaicin in the management of shingles pain, according to Seth John Stankus, MAJ, MC, et al. Stankus reports that tricyclic antidepressants and anticonvulsants along with the continued use of corticosteroids and topical treatments are used in the treatment of postherpetic neuralgia.