Postherpetic Neuralgia (PHN) – A Painful Flareup

Introduction

Postherpetic Neuralgia (PHN) is a painful neurological and skin condition. It is a complication of herpes zoster, also known as Shingles.

Shingles is a painful, blistering skin rash caused by the varicella-zoster virus reactivation.

This virus is typically contracted as chickenpox in childhood or adolescence. After childhood, the virus can lay dormant in the body’s nerve cells and reactivate decades later. Postherpetic Neuralgia occurs when the pain caused by shingles persists after the rash and blisters have healed.

There are several Paid Clinical Trials in Michigan near you that can help you and the countless others who suffer from this condition. We hope to reduce the number of COPD cases through preventive measures and advanced treatment options.

What are the Symptoms of Postherpetic Neuralgia?

Shingles are characterized by a painful, blistering rash. Postherpetic Neuralgia is a complication that only affects people who have previously experienced shingles. Postherpetic Neuralgia’s signs and symptoms are typically limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on one side of your body.

The following signs and symptoms characterize postherpetic Neuralgia (PHN):

• Severe pain that persists for more than 1 to 3 months in the same area where the shingles first appeared, even after the rash has faded.
• Even the slightest pressure causes a burning sensation on the skin.
• Sensitivity to touch or temperature changes.

Muscle weakness or paralysis may occur in rare cases if the nerve also controls muscle movement. Some daily activities, such as bathing or dressing, may be challenging to perform due to symptoms. PHN can also cause fatigue and sleep problems.

What Causes Postherpetic Neuralgia?

Postherpetic Neuralgia begins with a very common illness: Chickenpox. It is caused by the varicella-zoster virus. When chickenpox clears, the virus “hides out” in your nervous system.

Doctors aren’t sure why, but the virus can reactivate decades later and travel through pathways to your skin. A painful, blistering rash may appear. That’s shingles. Shingles can damage your nerves in some cases, preventing them from sending messages from your skin to your brain as they normally do. This signal jumble can result in the ongoing pain of neuralgia. Pain that lasts more than a year may become permanent.

Who can get affected by Postherpetic Neuralgia?

One out of every five people who get shingles will have these sharp, ongoing pains. Certain factors, however, can increase your chances of getting it:

• Age: The majority of people who develop Postherpetic Neuralgia (PHN) are over the age of 60.
• Gender: Women appear to be more affected than men.
• Early symptoms: People who experience numbness, tingling, or itching before a shingles rash appears are more likely to experience lingering pain later.
• Pain at the start: If you experienced severe pain or a rash at the start of your outbreak, you are more likely to develop neuralgia later.
• Other health issues: People who have ongoing conditions that can weaken the immune system, such as HIV or cancer, appear to be more likely to get it.

How can we Manage Postherpetic Neuralgia (PHN)?

There are certain things you can do on your own to try to relieve the pain from Postherpetic Neuralgia. Medicines can also be used to help with pain relief.

Self-help

To alleviate the pain and irritability of post-herpetic neuralgia:

• Wear comfortable clothing, preferably cotton or silk, as these are less likely to irritate the skin.
• Use cling film or a plastic wound dressing to protect the painful area.
• Use cold packs – some people find that wrapping an ice pack in a towel and applying it to the affected area helps to cool the skin, but do not apply ice directly to the skin.

Medications

Medicines may not completely relieve pain, but they can certainly help. You may need to try several medications before determining which one, or combination of medications, works best for you.

Pain relievers that are commonly used do not usually work for Postherpetic Neuralgia. However, your doctor may advise you to start with paracetamol or a combination of paracetamol and codeine to see if it helps. Some antidepressant medications also treat nerve pain, so you may be advised to try one of these.

• Antidepressants:

Amitriptyline and Duloxetine are the two most commonly prescribed antidepressants for Postherpetic Neuralgia. You’ll usually start on a low dose, which will be gradually increased based on the benefits and side effects. It could take several weeks to feel the full effects.

Dry mouth, constipation, dizziness, and drowsiness are common side effects. Not everyone experiences side effects. If these medications continue to be ineffective after several weeks, or if they are causing significant side effects, your dose will need to be gradually reduced to avoid withdrawal symptoms.

• Anticonvulsants:

Gabapentin and Pregabalin are the two most commonly prescribed anticonvulsants for Postherpetic Neuralgia. They, like antidepressants, should be started slowly and gradually increased over a few days or weeks. They also need to be taken for a few weeks before they begin to work.

When taking gabapentin and pregabalin, dizziness, drowsiness, poor memory, increased appetite, and weight gain are some of the possible side effects. However, not everyone experiences side effects. If these medications continue to be ineffective after several weeks, or if they are causing significant side effects, your dose will need to be gradually reduced.

• Creams and Plasters:

Your doctor can prescribe some topical medications that you can apply directly to the painful area.

If your pain is mild or you are unable to take antidepressants or anticonvulsants, your doctor may recommend these treatments. If your pain is severe, your doctor may prescribe them in conjunction with other medications.

Lidocaine plasters: Lidocaine plasters are adhesive plasters containing a local anesthetic. They can be helpful when pain interferes with sleep or daytime activity. They can only be used for a maximum of 12 hours at a time.

Capsaicin cream: For nerve pain, a low-dose cream containing Capsaicin can be prescribed. It can prevent nerves from sending pain signals to the brain. It is applied to the affected area several times daily, but only after the rash has healed. It works by changing how nerve endings function. If the treatment is effective, it can be repeated every few months, depending on how your symptoms have improved.

There is no clear-cut superior treatment for PHN. Your doctor may advise you to try more than one medication or to take several medications at the same time. You and your provider will talk about your options and what makes sense for you to try. If your pain does not go away after taking your medication, contact your doctor. Take your medications exactly as directed.

What are the Complications of Postherpetic Neuralgia?

Depending on how long Postherpetic Neuralgia lasts and how painful it is, people with the condition may develop other chronic pain symptoms such as:

• Depression
• Fatigue
• Sleeping problems and a lack of appetite
• Concentration problems

What is the Prognosis for Postherpetic Neuralgia?

The majority of people who develop PHN have a good prognosis, though they may need to take pain medications for one to three months. Others have a fair to poor prognosis if their pain is severe, lasts longer than three months, or significantly reduces their quality of life. Although PHN can cause permanent nerve damage, the disease is not fatal.

Who should be Immunized against Shingles?

The Shingles vaccine is advised for healthy adults aged 50 and older. There is no upper age limit. You should still get the vaccine if:

• You have Shingles.
• You’re not sure if you’ve had chickenpox (roughly 99% of Americans over the age of 40 have had chickenpox, even if they don’t remember getting it as a child).
• You have already received the Zostavax vaccine.

In the United States, this Shingles vaccine is no longer available. Ask your doctor about the best time to get the Shingles vaccine. If you currently have shingles, you must wait until the rash has healed. Consult your healthcare provider about the best time to begin Shingles vaccination.

Keeping Postherpetic Neuralgia at Bay — Prevention

There is no certain way to prevent Postherpetic Neuralgia (PHN) from happening. However, by treating shingles early with antiviral medication, the risk of complications such as Postherpetic Neuralgia is reduced.

If you develop shingles-like symptoms such as pain or a rash, see your doctor as soon as possible to discuss taking an antiviral medication. Getting vaccinated against shingles will help you avoid getting the infection in the first place. If you’ve previously had shingles, the vaccine will reduce your chances of getting it again.

Outlook

Postherpetic Neuralgia is the most common Shingles complication. The condition affects nerve fibers and skin, causing burning pain that lasts longer even after the rash and blisters of shingles disappear. One in every three people in the United States will get shingles at any time in their life. Postherpetic Neuralgia affects 10% to 18% of shingles patients.

Postherpetic Neuralgia becomes more common with age, primarily affecting people over the age of 60. There is no cure available for PHN, but treatments can help to relieve symptoms. Postherpetic Neuralgia usually improves with time. Revival Research Institute is conducting Postherpetic Neuralgia (PHN) Clinical Trials in Michigan to assist researchers and doctors in better understanding the condition and identifying potential treatment options that may be able to help those in need.