PT Classroom - Post Herpetic Neuralgia ׀ by Jay Hurh, MD, MPH


Upon completion of his undergraduate degree, Dr. Jay Hurh entered graduate school with a focus on molecular biology and the study of disease patterns in society. Dr. Hurh’s research background and his interest in the relevance of research in the clinical setting led him to the field of medicine. After medical school, Dr. Hurh completed a residency in anesthesiology and a fellowship in interventional pain management at the Medical College of Wisconsin, where he was one of two chief residents for the program. With a background in the research of basic sciences and extensive clinical training, Dr. Hurh has a well-rounded perspective for the treatment of patients with difficult and painful conditions.

What is post herpetic neuralgia?
Post herpetic neuralgia is pain that remains where the rash from shingles occurred long after the rash has healed. Shingles is an infection of the nerves caused by the varicella-zoster virus, the same virus that causes chickenpox. The medical term for shingles is herpes zoster.

About one-third of the people who get shingles will get post herpetic neuralgia. The pain can last for months to years after the shingles outbreak. The older you are, the more likely you are to develop post herpetic neuralgia. Typically, the worse the rash, the more likely the pain will be severe and long-lasting.

How does it occur?
Most people in the US get chickenpox as children. Once the chickenpox infection has cleared, the virus lies dormant inside nerve roots.

Years later, if your immune system gets very stressed or weak, the virus can reemerge. Instead of causing chickenpox to reoccur, it causes shingles, which produces a painful, blistering rash. If pain remains after the blisters have dried up and gone away, you have post herpetic neuralgia. The pain is due to damage to the nerves.

Your immune system can be stressed or weakened by:
• normal aging
• chronic diseases such as rheumatoid arthritis
• cancer and cancer treatment
• certain medications
• strong infections such as pneumonia or by being immune-compromised as with AIDS

One or more of these conditions can cause the virus to become active again. If shingles results, so does the possibility of post herpetic neuralgia.

What are the symptoms?
The pain of post herpetic neuralgia may be stabbing, aching, burning, and constant. Some people can become overwhelmed and depressed by having to cope with ongoing pain daily.

Post herpetic neuralgia may also result in:
• fatigue
• loss of appetite
• loss of enjoyment
• inability to perform usual daily tasks because of the pain

How is it diagnosed?
There are no special tests for post herpetic neuralgia. The diagnosis is based on having pain that persists after the rash of shingles has disappeared.

How is it treated?
A variety of treatments have been tried to ease the pain of post herpetic neuralgia. What is effective for one person may not be for another. If a treatment does not work, tell your health care provider.

Your provider might prescribe:
• medications in the form of creams or pills
• acupuncture
• transcutaneous electrical nerve stimulation (TENS)
• cold packs
• interventional therapy such as nerve blocks

How long will the effects last?
The pain can last for months to years.

How can I take care of myself?
You may find the following helpful:
• Take all medicines as directed by your health care provider.
• Let your provider know what in your treatment plan works and what doesn't.
• Eat a healthy diet that is low in saturated fats and includes fruits and vegetables that can help to keep your immune system strong.
• Get enough sleep.
• Get 20 to 30 minutes of aerobic exercise (such as walking or swimming) daily.
• If you are feeling emotionally overwhelmed by daily pain, let your health care provider know. You may want to look within your community for chronic pain support groups.

What can be done to prevent it?
A vaccine is now available for the varicella-zoster virus that protects against chickenpox and the development of shingles and post herpetic neuralgia later in life. The vaccine is effective for those who have never had exposure to the virus, so it will not be helpful for most adults in the US. Eventually, as more children are vaccinated for the virus, chickenpox outbreaks should become less widespread and fewer adults will get shingles.

Tell your health care provider if you suspect that you are developing shingles because early drug therapy may help shorten the length of symptoms. Talk to your doctor to see if such therapy is appropriate for you.


Last revised: February 12, 2010
by Jay Hurh, MD, MPH

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