Postherpetic Neuralgia

Postherpetic neuralgia is pain, headaches, and nerve problems that occur as a complication of shingles (herpes zoster). Postherpetic neuralgia lasts for at least 30 days and can continue for months to years.

People who develop shingles after age 50 and who have severe pain and rash during shingles have the greatest risk for having postherpetic neuralgia. It most commonly occurs on the forehead or chest. The pain associated with postherpetic neuralgia may make it difficult to eat, sleep, and do daily activities. It may also increase the risk for depression.

Early treatment of shingles with antiviral medicines may prevent postherpetic neuralgia. After postherpetic neuralgia occurs, certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain.

Sometimes the pain of postherpetic neuralgia can be controlled with over-the-counter medicines, such as:

• Pain medicines (analgesics), such as acetaminophen, aspirin, or ibuprofen.
• Anesthetics (such as benzocaine), which are available in forms that you can apply directly to the skin for pain relief. Anesthetics cause partial or complete loss of feeling when applied to a particular area of skin around the area of pain.
• Medicines containing capsaicin, such as Zostrix. When applied to the skin, capsaicin blocks the skin's nerve impulses, stopping pain without interfering with other sensations.

Prescription medicines used to treat postherpetic neuralgia include:

• A high-dose capsaicin patch (Qutenza). Capsaicin blocks the skin's nerve impulses and helps to relieve pain for most people. In a few people, it may burn or irritate the skin where it is applied.
• The lidocaine patch (Lidoderm), which is applied directly to the painful skin area. The lidocaine patch numbs the area, is simple to use, and causes no known serious side effects.
• Corticosteroid injections (sometimes used with other medicines), which may reduce the pain in the area of affected skin.
• Tricyclic antidepressants (such as amitriptyline), which interfere with the chemical substances that send pain messages.
• Anticonvulsants (such as gabapentin), which can relieve pain by calming the nerve pathways that send pain signals.
• Nerve block injections (anesthetic shots around the infected nerve), which temporarily relieve pain.
• Opioids (such as codeine), which suppress the feeling of pain.