Chronic pain that continues after a case of shingles is called postherpetic neuralgia (PHN). It is estimated that about 20% of patients will experience this type of nerve pain as a complication of shingles.
Those who have had chickenpox (herpes zoster virus) are at risk of developing shingles later in life. People who develop PHN are generally age 60 and older. Although there is no cure for PHN, there are several methods of pain management that can ease symptoms. Fortunately, the type of pain that arises from postherpetic neuralgia improves over time.
Neuralgia affects the nerves, causing structural and functional damage. It can feel like a stabbing or burning pain that radiates along the affected nerve.
Neuropathic pain is not caused by an external injury or stimuli but originates from inside the nervous system. When the herpes-varicella zoster virus is reactivated in the form of shingles, scar tissue forms alongside nerves, creating pressure, and sending pain signals to the brain.
As if the pain from shingles wasn’t bad enough, many people also must endure the nerve pain that comes afterward. Here are several ways to treat PHN:
- Anticonvulsants. Some anti-seizure medications like gabapentin (Neurontin, Horizant) and pregabalin (Lyrica) can decrease the pain of postherpetic neuralgia. These medications can stabilize erratic electrical activity in the nervous system caused by damaged nerves. Side effects include foggy thinking, drowsiness, dizziness, and swelling in the feet.
- Painkillers. If the pain is bad enough, some may be prescribed pain medications that contain tramadol (Conzip, Ultram), oxycodone (Percocet), or morphine. Side effects of opioids can include drowsiness, constipation, and confusion. The CDC recommends other treatments besides opioids because the risk factors of dependency, and even death, are considerable.
- Steroids. Sometimes a corticosteroid medication is injected around the spinal cord. Although steroids should not be administered until the pustular rash caused by shingles has gone away.
- Lidocaine Skin Patches. These patches contain a topical ointment with the medication lidocaine that may be purchased over-the-counter. These can relieve burning, itching, pain from inflammation, and be cut so they only cover the affected area.
- Capsaicin Skin Patches. Capsaicin, an extract from chili powders, is also available as a skin patch (Qutenza) that can relieve pain. This patch can only be applied by trained personnel at your doctor’s office. Because of the medication’s high concentration, you will need to remain at the doctor’s office for a couple of hours so they can monitor you. Some patients experience pain relief for several months just from a single application.
- Antidepressants. These regulate brain chemicals, hormones, like norepinephrine and serotonin which affect how our bodies interpret pain. Examples of these tricyclic antidepressants include nortriptyline (Pamelor), amitriptyline, desipramine (Norpramin), and duloxetine (Cymbalta). Risk factors may include fatigue, lightheadedness, dry mouth, and weight gain.
Spinal Cord or Peripheral Nerve Stimulation
These are often used to treat several different types of neuropathic pain. Electrodes are placed underneath the skin along the affected peripheral nerves. Before using this technique, doctors will do a test using a wire electrode to get a sense of how the patient will respond.
After the electrodes have been placed above the peripheral nerve, a weak electrical current is sent to the nerve. By stimulating a sensory pathway that doesn’t cause pain, experts believe that this electrical signal to the brain can trick the brain into turning off the painful signal, bringing relief to the patient.
The Centers for Disease Control and Prevention (CDC) recommends that people over the age of 50 get the Shingrix vaccine to prevent shingles. It is administered in 2 doses, 2 to 6 months apart.
People who should not take the Shingrix vaccine include:
- People who have a reaction to the antibiotic neomycin, gelatin, or any other component of the shingles vaccine
- People with weakened immune systems
- Those who have had bone marrow or lymphatic cancer
- Those who have untreated tuberculosis (TB)
- People who are on steroids and those who are being treated with chemotherapy, radiotherapy, or both
Have you experienced the pain of shingles and are now experiencing nerve pain? Are you interested in participating in a clinical trial? We have a wide variety of clinical trials available if you qualify and meet specific criteria.