Postherpetic Neuralgia: What to Do About Nerve Pain After Shingles
After the immune system clears out an initial infection of chickenpox, the virus that causes it lives inactive in your body without causing symptoms. The virus lies dormant, typically hiding in the nerves along the spinal cord or the base of your skull. Sometimes, the virus can reactivate and cause shingles.
Postherpetic neuralgia is the most common complication of shingles. It can last a few weeks to several years.
This article explains the risk factors for postherpetic neuralgia, as well as the symptoms and treatment. It will discuss new and experimental treatment of postherpetic neuralgia.
Postherpetic neuralgia affects the area where the shingles blisters appear. People often describe it as burning or stinging pain. It can range from mild to severe and interfere with daily activities.
Shingles often appears in a line or band across one side of your body or elsewhere, like your face, eye, or an arm. Mild to moderate burning pain along this area is characteristic of shingles. For most people, the shingles rash clears up in about 10 days and symptoms go completely away in 2–4 weeks.
Postherpetic neuralgia is pain, burning, or stinging in the area of the shingles rash for at least 90 days beyond the initial shingles outbreak.
Symptoms of postherpetic neuralgia include:
- aching to sharp pain that comes and goes or remains constant
- itching or numbness
- worsening pain at night
If you recently had shingles and the pain continues past the 2–4 week mark, tell your doctor. They can evaluate your symptoms and medical history and discuss next steps. There are treatment options for postherpetic neuralgia, even if you did not treat the shingles outbreak.
Postherpetic neuralgia can happen if the shingles virus infection damages the nerves. A 2019 overview of shingles indicated that 10–20 out of 100 people who get shingles develop postherpetic neuralgia.
The risk of developing postherpetic neuralgia increases with age, notes the Centers for Disease Control and Prevention (CDC). The 2019 overview pointed to older studies showing that 60% of 60-year-olds and 75% of 70-year-olds develop postherpetic neuralgia after a shingles rash.
Aside from age, which experts believe puts us at greater risk because of naturally weakening immune systems, factors that raise the chance of developing postherpetic neuralgia include:
- severe immunosuppression, either from medication or illness
- outbreak of shingles that damages nerves
- allodynia, a condition in which people experience pain in situations that do not usually cause pain
- shingles in or around the eye
Management of postherpetic neuralgia includes a combination of medications you take by mouth and medicated lotions you apply to the affected area. With mild pain, your doctor may start with over-the-counter pain relievers and lidocaine patches or lotions. There are no medications yet that can cure the condition.
Medication and nerve stimulation
Treatments for moderate or severe pain, recommended by the American Academy of Neurology and other organizations, include:
- tricyclic antidepressant
- antiseizure medication
- 5% lidocaine patch
- extended-release pregabalin (Lyrica CR)
- 8% capsaicin patch
Other potential treatments include:
- nerve blocks
- neuromodulation, such as transcutaneous electrical nerve stimulation
- acupuncture, which may be equivalent to or better than traditional medicated treatments
If traditional treatment is not effective, other treatments under study to ask your doctor about include:
- high voltage pulsed radiofrequency, a small 2021 study involved people with postherpetic neuralgia of the first branch of the trigeminal nerve
- scrambler therapy, a stimulation device
- magnesium sulfate and ketamine infusion therapy
A 2020 research review involving studies of botulinum toxin (Botox) to treat postherpetic neuralgia showed that it may provide greater pain relief than lidocaine patches. The procedure involves Botox injections under the skin.
Opioids no longer prescribed
Opioids are not a common pain management strategy for postherpetic neuralgia because they are habit-forming. However, some doctors might prescribe them for severe pain when other treatments are not effective.
One home remedy for postherpetic neuralgia to ask your doctor about includes crushed aspirin mixed in a lotion and applied to the painful area of skin, avoiding eyes and mouth. Another is mindfulness meditation, which provided some pain relief for participants in a 2015 study.
It is possible to prevent postherpetic neuralgia by taking medication at the first symptoms of a shingles infection. Doctors treat shingles with antiviral medications like acyclovir. Starting them within 72 hours of the rash outbreak may give the best results. These drugs can shorten the course of disease and reduce the chance of postherpetic neuralgia.
Preventing shingles also prevents postherpetic neuralgia. The recombinant zoster vaccine, known as Shingrix, is an effective vaccine for people ages 50 and older to prevent shingles.
This vaccine is 97% effective at preventing shingles in adults ages 50–69 years who do not have weakened immune systems, and 91% effective at preventing postherpetic neuralgia in adults 50 and older.
The CDC also recommends Shingrix for people 19 and older with reduced immune system function. The shingles vaccine is appropriate even if you had shingles or received the chickenpox vaccine.
Learn more about who should receive the shingles vaccine.
Here are some other questions that people ask about postherpetic neuralgia.
Is nerve damage and postherpetic neuralgia from shingles permanent?
Shingles can cause permanent nerve damage in places where the shingles rash appears. Rarely, postherpetic neuralgia is a permanent condition.
How long does postherpetic neuralgia last?
Postherpetic neuralgia can last from a few weeks to several years.
What causes postherpetic neuralgia to flare up?
Doctors do not know why postherpetic neuralgia pain might come and go. Causes may include low immune system function, stress, or illness.
Postherpetic neuralgia is the most common complication after experiencing a shingles outbreak. It can happen if the shingles virus damages nerves underlying the rash. This causes a burning or stinging pain that often lasts a few weeks or months but rarely longer.
It is important to contact your doctor at the first symptom of a shingles infection for treatment that can decrease symptoms and the likelihood of developing postherpetic neuralgia. After you are 50 years old, the shingles vaccine. can be a great way to prevent shingles and postherpetic neuralgia.