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Signs & Symptoms of Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a condition that occurs in many people who have experienced a flare-up of the varicella-zoster virus (VZV), leading to a shingles outbreak. Shingles causes pain, which can be quite severe, along with a rash. Postherpetic neuralgia occurs when the pain of shingles does not subside at the same time as does the rash.

  1. Shingles

    • Postherpetic neuralgia occurs in people who have had a shingles outbreak; this is a necessary precondition. The pain of shingles, which occurs along the path of the nerve in which the virus has again become active, is generally accompanied by a red rash and blisters along the same path. Pain that persists after this rash has cleared up is postherpetic neuralgia.

      One factor that may complicate a diagnosis of PHN is the absence of an initial rash. This is a condition known as zoster sine herpete; another condition, called zoster cum herpete minimo, involves a very slight rash that may be overlooked. These conditions, however, are much more rare than shingles with rash.

    Time Frame

    • Postherpetic neuralgia mostly affects people over the age of 60. According to the Mayo Clinic, half of all people who develop shingles over the age of 60 develop PHN, while only 10% of others experience the condition. Being vaccinated against shingles can reduce one's chances of developing PHN; see Resources to learn more about vaccination.

    Symptoms

    • Along with pain along the affected nerve, which is generally quite severe in the event that it lasts after rash clears up, PHN may present with the following symptoms, according to the Mayo Clinic: sensitivity to both touch and change in temperature, itching, numbness and headache.

    Effects

    • The Mayo Clinic reports that PHN occurs as the result of nerve damage sustained during shingles outbreak. The use of corticosteroids during shingles outbreak to manage nerve swelling reduces the risk of developing nerve damage and is therefore an important element of treatment.

    Treatment

    • Because the pain of PHN is severe, traditional, over-the-counter pain relievers are generally ineffective. Therefore, according to Seth John Stankus, MAJ, MC, et al., the use of narcotic (prescription) pain relievers is necessary. Also used in the treatment of PHN pain are lowered doses of tricylic antidepressants and anticonvulsants as well as corticosteroids and topical relief from lidocaine patches and capsaicin cream. Capsaicin cream may be cause a severe burning feeling for some, however, and may therefore be avoided.

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