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A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.

A.D.A.M. Medical Encyclopedia.

Postherpetic neuralgia

Last reviewed: June 28, 2011.

Postherpetic neuralgia is pain that lasts for more than a month after a shingles infection occurred. The pain may last for months or years.

Causes, incidence, and risk factors

Postherpetic neuralgia occurs when the nerves have been damaged after an outbreak of shingles. Shingles is caused by the varicella zoster virus, the same virus that causes chickenpox.

Postherpetic neuralgia is more likely to occur in people over age 60.

Symptoms

The main symptom is pain in the area where shingles once occurred.

  • The pain can range from mild to very severe. It may continue, or come and go.

  • The pain is described as a deep aching, burning, stabbing, or feeling like an electric shock.

  • People with this pain are very sensitive to touch or temperature changes.

The pain lasts for months or sometimes years after the shingles infection.

Treatment

Anticonvulsant drugs, usually used for seizures, may help with the pain of damaged nerves. Gabapentin and pregabalin are the ones most often used to treat postherpetic neuralgia.

Skin patches with lidocaine (a numbing medicine) may also be prescribed to relieve some of the pain for a period of time.

Pain medications are often needed. Sometimes acetaminophen or NSAIDs such as ibuprofen are enough. Many patients will need stronger, prescription drugs such as codeine, hydrocodone, or oxycodone.

Drugs used to treat depression (antidepressants) may also help reduce pain, as well as help with sleep.

Electrical nerve stimulators may be used for severe, long-term cases of postherpetic neuralgia.

Some people may need help from a pain specialist.

Prevention

A herpes zoster vaccine is available. It is different from the chickenpox vaccine that children or young adults may receive. Adults over age 50 should get the herpes zoster vaccine as part of their routine medical care.

A single shot of the vaccine can cut the risk of getting shingles by about half. It may also help prevent postherpetic neuralgia and ophthalmic herpes.

Because the vaccine contains a live virus, it cannot be given to people who have a weak immune system.

References

  1. Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2011. Ann Intern Med. 2011;154:168-173.
  2. Chen N, Li Q, Zhang Y, Zhou M, Zhou D, He L. Vaccination for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2011 Mar 16;3:CD007795. [PubMed: 19370655]
  3. Wilson IF. Herpes zoster. Ann Intern Med. 2011;154:ITC31-15.

Review Date: 6/28/2011.

Reviewed by: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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What works?

  • Topical lidocaine (a local anaesthetic) for the treatment of postherpetic neuralgia (nerve pain) Topical lidocaine (a local anaesthetic) for the treatment of postherpetic neuralgia (nerve pain)
    Topical lidocaine may benefit some patients on an individual basis though there is stronger evidence for the use of other drugs. Postherpetic neuralgia is a long‐lasting pain disorder that causes pain from stimuli that are not normally painful. Local anaesthetics (such as lidocaine) can reduce the sensation of pain that is transmitted through nerves, and allow pain relief in patients with postherpetic neuralgia. This review found three small studies involving 182 topical lidocaine treated participants and 132 control participants using lidocaine for patients with postherpetic neuralgia. Two studies provided data on pain relief amongst patients with postherpetic neuralgia, and they showed some improvement in pain when topical lidocaine was compared to a placebo. No comparison was made with other medications that are in current use for the treatment of postherpetic neuralgia. The side effects of topical lidocaine are very minimal, but include skin problems (such as irritation and redness). We are unable to recommend the use of topical lidocaine as a first‐line treatment for postherpetic neuralgia at this stage. Further studies are needed to compare topical lidocaine to other medications in the treatment of postherpetic neuralgia.
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Drugs of interest

  • Gabapentin
    Gabapentin capsules, tablets, and oral solution are used to help control certain types of seizures in people who have epilepsy. Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down). Gabapentin is in a class of medications called anticonvulsants. Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.
  • Pregabalin
    Pregabalin is used to relieve neuropathic pain (pain from damaged nerves) that can occur in your arms, hands, fingers, legs, feet, or toes if you have diabetes or in the area of your rash if you have had shingles (a painful rash that occurs after infection with herpes zoster). It is also used to treat fibromyalgia (a long-lasting condition that may cause pain, muscle stiffness and tenderness, tiredness, and difficulty falling asleep or staying asleep). Pregabalin is used with other medications to treat certain types of seizures in people with epilepsy. Pregabalin is in a class of medications called anticonvulsants. It works by decreasing the number of pain signals that are sent out by damaged nerves in the body.
  • Oxycodone
    Oxycodone is used to relieve moderate to severe pain. Oxycodone is in a class of medications called opiate (narcotic) analgesics. It works by changing the way the brain and nervous system respond to pain. Oxycodone is also available in combination with acetaminophen (Endocet, Percocet, Roxicet, Tylox, others); aspirin (Endodan, Percodan, Roxiprin, others); and ibuprofen (Combunox). This monograph only includes information about the use of oxycodone alone. If you are taking an oxycodone combination product, be sure to read information about all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.
  • Codeine
    Codeine is used to relieve mild to moderate pain. It is also used, usually in combination with other medications, to reduce coughing. Combination products that contain codeine and promethazine should not be used in children younger than 16 years of age. Codeine will help relieve symptoms but will not treat the cause of symptoms or speed recovery. Codeine belongs to a class of medications called opiate (narcotic) analgesics and to a class of medications called antitussives. When codeine is used to treat pain, it works by changing the way the body senses pain. When codeine is used to reduce coughing, it works by decreasing the activity in the part of the brain that causes coughing. Codeine is also available in combination with acetaminophen (Capital and Codeine, Tylenol with Codeine); aspirin; and in many cough and cold medications. This monograph only includes information about the use of codeine. If you are taking a codeine combination product, be sure to read information about all the ingredients in the product you are taking and ask your doctor or pharmacist for more information.
  • Acetaminophen
    Acetaminophen is used to relieve mild to moderate pain from headaches, muscle aches, menstrual periods, colds and sore throats, toothaches, backaches, and reactions to vaccinations (shots), and to reduce fever. Acetaminophen may also be used to relieve the pain of osteoarthritis (arthritis caused by the breakdown of the lining of the joints). Acetaminophen is in a class of medications called analgesics (pain relievers) and antipyretics (fever reducers). It works by changing the way the body senses pain and by cooling the body.
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