How Do I Know If I Have Postherpetic Neuralgia?

Reviewed on 3/10/2021

Postherpetic neuralgia is a complication of a painful rash called shingles, which is caused by the varicella-zoster virus (the same virus that causes chickenpox). If you have been diagnosed with shingles and the rash has gone away, but pain persists, you may have postherpetic neuralgia.
Postherpetic neuralgia is a complication of a painful rash called shingles, which is caused by the varicella-zoster virus (the same virus that causes chickenpox). If you have been diagnosed with shingles and the rash has gone away, but pain persists, you may have postherpetic neuralgia.

If you have been diagnosed with shingles and the rash has gone away, but pain persists, you may have postherpetic neuralgia. 

Symptoms of postherpetic neuralgia follow a bout of shingles, and may include pain that: 

  • Can range from mild to severe
  • Often never went away after a bout with shingles, though in rare cases the pain may occur months to years later
  • Usually has a sharp, stabbing, or burning quality
  • May be constant or intermittent
  • May occur even on light touch (allodynia)
  • Can be so severe it interferes with daily activities, sleep, appetite, and sex drive
  • Is often worse in older adults than in younger people
  • There may also be areas of numbness

What Is Postherpetic Neuralgia?

Postherpetic neuralgia is a complication of a painful rash called shingles, which is caused by the varicella-zoster virus (the same virus that causes chickenpox). 

In up to 15% of people who have shingles, the pain associated with the condition does not go away when the rash disappears. This chronic pain is postherpetic neuralgia.

What Causes Postherpetic Neuralgia?

Postherpetic neuralgia is caused by nerve damage due to shingles. Shingles is caused by the varicella-zoster virus. After a person has chickenpox, the varicella-zoster virus remains dormant in the body but can become reactivated later in life, causing shingles. When the pain of shingles persists, it is postherpetic neuralgia.

Risk factors for developing postherpetic neuralgia include: 

How Is Postherpetic Neuralgia Diagnosed?

Most of the time, postherpetic neuralgia is easy to diagnose because it results from pain that persists after a documented case of shingles. The diagnosis is made based on the clinical presentation alone.  

Factors that can support a diagnosis of postherpetic neuralgia include: 

  • Advanced age (postherpetic neuralgia is common in people aged 50 years and older)
  • Severe prodromal pain with acute herpes zoster 
  • Severe rash that preceded the pain
  • Distribution of pain in certain areas of skin supplied by specific nerves (trigeminal or brachial plexus dermatomes)
  • The presence of pain on light touch

What Is the Treatment for Postherpetic Neuralgia?

Up to 50% of patients with postherpetic neuralgia do not respond to treatment.

Treatments for postherpetic neuralgia pain include: 

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What Are Complications of Postherpetic Neuralgia?

The main complication of postherpetic neuralgia is that the pain may persist for years, or even for the rest of your life.

How Do You Prevent Postherpetic Neuralgia?

The main way to help prevent shingles, which can lead to postherpetic neuralgia, is vaccination. There are two vaccines available for adults 50 years and older to reduce the chance of developing shingles.

  • Zostavax (zoster vaccine live) is available in a single dose. Zostavax reduces the risk of developing shingles by 51% and postherpetic neuralgia by 67%. Protection from the Zostavax vaccine lasts about 5 years.
  • Shingrix (recombinant zoster vaccine) requires two doses administered two to six months apart. The two-dose Shingrix vaccine is preferred because it is more than 90% effective at preventing shingles and postherpetic neuralgia. Protection from the Shingrix shingles vaccine stays above 85% for at least four years after vaccination. 

Antiviral agents or use of amitriptyline taken within 72 hours of the onset of shingles can reduce the intensity and duration of acute illness, and may also help prevent postherpetic neuralgia.

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Reviewed on 3/10/2021
References
https://www.uptodate.com/contents/shingles-beyond-the-basics?search=postherpetic%20neuralgia&source=search_result&selectedTitle=3~60&usage_type=default&display_rank=3

https://www.uptodate.com/contents/postherpetic-neuralgia?search=postherpetic%20neuralgia&source=search_result&selectedTitle=1~60&usage_type=default&display_rank=1

https://www.aafp.org/afp/2005/0215/p808.html

https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/index.html https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html