Treating Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a painful, chronic condition that sometimes develops following an attack of shingles. Even after the acute rash of shingles subsides, pain can persist in shingles-affected areas. With PHN, the pain persists for longer than four months after the onset of the rash. PHN occurs most often in elderly people and in patients whose immune systems have been compromised.

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It's not well understood why pain persists after the shingles rash goes away, but scientists believe it may be caused by the varicella-zoster virus leaving scarring or other lesions in the cells in sensory ganglia and associated nerves.

Although postherpetic neuralgia can be extraordinarily painful, it is not life threatening. Even in severe cases, the paralysis, headaches, and pain generally subside over time. Treating shingles with antivirals at the first sign of the rash--within the first 72 hours--is believed to reduce the risk of postherpetic neuralgia and may speed up the healing process.

To treat the pain of postherpetic neuralgia, powerful narcotic pain relievers can offer relief, but, because they can have serious side effects, doctors often prescribe newer nonaddictive painkillers. Doctors may also prescribe ointments containing capsaicin, the heat-producing ingredient found in hot chili peppers, to relieve pain from postherpetic neuralgia.

A lidocaine patch allows the drug, an anesthetic, to be released into the top layers of the skin and reduces pain from the damaged nerves. Because it delivers the drug via the skin, it does not produce any significant levels of the drug in the blood and shouldn't cause serious systemic side effects.

Studies have also shown that some anticonvulsant drugs used to treat epilepsy, such as carbamazepine, are sometimes effective, as are antidepressants. Some doctors report that patients occasionally benefit from alternative treatments for pain, such as acupuncture and electrical stimulation of nerve endings.