What increases the risk of long-lasting pain?

The risk of developing post-herpetic neuralgia increases with age. Four weeks after getting shingles, nerve pain is still felt by about

• 30% of 55 to 59-year-olds,
• 50% of people over the age of 60, and
• 70% of people over the age of 70.

Women seem to be more likely to have long-lasting nerve pain than men. Post-herpetic neuralgia is also more likely to develop if your eyes were affected by shingles.

Can post-herpetic neuralgia be prevented?

Box

Vaccination can prevent shingles – so it can prevent post-herpetic neuralgia, too.

People who have a severe case of shingles, or a higher risk of developing complications, are often advised to take antiviral (virus-fighting) drugs to try to prevent post-herpetic neuralgia.

Several studies have tested whether antiviral therapy can actually prevent long-lasting nerve pain. They showed that treatment with the antiviral drug aciclovir did not prevent post-herpetic neuralgia: The same number of people still had pain both four and six months after having shingles – regardless of whether they had taken aciclovir or a fake drug (placebo).

There is not enough research on the other antiviral drugs brivudine, famciclovir and valaciclovir to be able to say whether they can prevent post-herpetic neuralgia.

In rare cases, preventive treatment with steroids is also recommended. Steroids can be taken in the form of tablets or injected into a muscle. But research has shown that this also doesn't have any advantages over treatment with a placebo.

How is post-herpetic neuralgia treated?

Lasting nerve pain can be treated in different ways:

• with anticonvulsants (anti-epileptic drugs),
• painkillers,
• antidepressants (anti-anxiety drugs), or
• anesthetic (pain-numbing) patches.

Anticonvulsants like pregabalin or gabapentin are often used for persistent nerve pain. It takes a while for them to start working, so they are combined with painkillers to start off with. The treatment with painkillers can then be stopped.

If the anticonvulsants don't help enough, it's possible to take antidepressants as well. Both drugs reduce the transfer of pain signals to the brain and lower the sensitivity of the affected nerves.

If the pain is limited to one area of the body, patches with anesthetic drugs such as lidocaine or capsaicin could help. Studies suggest that patches with high doses of capsaicin (8%) can reduce nerve pain.

The right drug and combination will depend on how severe the pain is and how well tolerated the particular medicine is. For this reason, it's very important to describe the following to your doctor in as much detail as possible: how severe the pain is, how well the drugs are working, and whether you experience any side effects.

There is a lack of research on other types of treatments, such as acupuncture or TENS (transcutaneous electrical nerve stimulation). So it's difficult to say for sure whether they work and how well they are tolerated.

If the pain continues despite treatment, it may be a good idea to see a specialized pain therapist or neurologist, or to contact a pain center or pain clinic.

Sources

• Chen N, Li Q, Yang J et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2014; (2): CD006866. [PMC free article: PMC10583132] [PubMed: 24500927]
• Derry S, Rice AS, Cole P et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2017; (1): CD007393. [PMC free article: PMC6464756] [PubMed: 28085183]
• Derry S, Wiffen PJ, Moore RA et al. Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev 2014; (7): CD010958. [PMC free article: PMC6540846] [PubMed: 25058164]
• Gross EG, Eisert L, Dörr HW et al. S2k-Leitlinie zur Diagnostik und Therapie des Zoster und der Postzosterneuralgie. GMS Infections Diseases 2020; 8: 1-31.
• Han Y, Zhang J, Chen N et al. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2013; (3): CD005582. [PubMed: 23543541]
• Moore RA, Chi CC, Wiffen PJ et al. Oral nonsteroidal anti-inflammatory drugs for neuropathic pain. Cochrane Database Syst Rev 2015; (10): CD010902. [PMC free article: PMC6481590] [PubMed: 26436601]
• Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) beim Robert Koch-Institut 2022 (Epidemiologisches Bulletin 04/2022). 2022.
• Ständige Impfkommission (STIKO). Wissenschaftliche Begründung für die Entscheidung, die Herpeszoster-Lebendimpfung nicht als Standardimpfung zu empfehlen. 2017.
• Wiffen PJ, Derry S, Bell RF et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2017; (6): CD007938. [PMC free article: PMC6452908] [PubMed: 28597471]

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