Postherpetic Neuralgia (PHN)

Shingles Nerve Pain After the Rash – Causes, Symptoms, Treatment

Jul 29, 2009
Katrena Wells

: PHN Symptoms, Treatment, Research - Katrena Wells

Postherpetic neuralgia, nerve pain associated with a shingles infection, may cause severe and long-lasting pain. Learn about PHN, treatment options, and research studies.

Shingles affects approximately 25% of adults, typically after age 40. Many of those suffering from shingles enjoy a complete recovery within a month of the onset of symptoms. However, half of people over 60 with a shingles outbreak may develop postherpetic neuralgia (PHN), which results in lingering nerve pain that may range from mild to severe.

PHN Causes

For some people, a shingles outbreak damages the nerves, resulting in improper communication from the brain to the skin. Persistent, and often severe, pain results from the damaged nerves and may last months to years after the shingles rash heals. People with a history of neuropathy, a disease of the nervous system, may be more likely to develop PHN.

Postherpetic Neuralgia Symptoms

Shingles, or acute herpes zoster infection, is a reactivation of the varicella zoster virus that causes chicken pox resulting in a rash along a nerve line anywhere on the body. Symptoms of PHN are usually limited to the area of the skin in which the outbreak appeared but may be smaller or larger than the size of the rash associated with the shingles. Symptoms of PHN vary and may include:

Pain that may be sharp, burning, or aching
Extreme sensitivity to touch
Extreme sensitivity to changes in temperature
Numbness
Itching
Headaches
Muscle weakness, sagging, or paralysis if affected nerves control muscles

Treatment Options for Postherpetic Neuralgia

Although no cure is available for PHN, several treatment options are available. The shingles vaccine has some promising results by preventing or lessening the symptoms of PHN for some people if the vaccine is administered during the early phase of a shingles outbreak. Habits to keep the body healthy may provide some protection from infections, including those from the herpes zoster virus. Many PHN treatments are aimed at pain control, and most people with PHN achieve at least partial pain control with treatment. Combined therapy is often necessary to achieve acceptable pain levels.

Tricyclic Antidepressants (Elavil, Cymbalta) are usually given in smaller doses than those for depression. These medications affect brain chemicals’ interpretation of pain.
Anticonvulsants (Neurontin, Lyrica) may help control pain by stabilizing abnormal electrical activity in the nervous system.
Steroid Injections may be an option after the shingles rash has healed.
Pain Killers (Ultram, drugs containing oxycodone) may be prescribed, but risks and benefits must be weighed as narcotics can become addictive.
Transcutaneous Electrical Nerve Stimulation (TENS) delivers small electrical pulses to stimulate nearby nerve pathways.
Spinal Cord Stimulation works like a TENS unit but is surgically implanted in the space above the spinal cord.
Peripheral Nerve Stimulation is similar to spinal cord stimulation but the electrode is inserted above a peripheral nerve.
Lidocaine Skin Patches may be cut to fit the area and applied to the skin for at least twelve hours and seem to provide local, temporary relief. Up to three patches may be used for large areas. These patches should not be applied to the face.
Capsaicin (Zostrix) is a topical cream made from hot chili pepper seeds. Unaffected areas can become very irritated if the cream comes into contact with unaffected skin, so gloves should be worn during application.
Psychological therapy (relaxation techniques, biofeedback) may help people to deal with chronic pain.
Treatment for problems that may stem from chronic pain, such as insomnia and depression, can also help.

Research Studies for Shingles and PHN Treatment

The National Institute of Neurological Disorders and Stroke is conducting research studies to provide more options for treatment of shingles and PHN. Examples of these studies include:

Looking at ways to increase the activity of macrophages and lymphocytes, the immune cells that seem to combat shingles.
Considering ways to block viral assembly and exit from nerve cells
Working toward improved vaccines for shingles and PHN
Discovering biological differences that may be present in people who do not develop PHN when compared with those who do develop PHN

Seek Healthcare Early for Postherpetic Neuralgia

Aggressive, early treatment for shingles, possibly including the shingles vaccine, tends to produce the best results in preventing or lessening complications of shingles, including PHN. Although no curative treatment is available at this time, people suffering from PHN now have more options for symptom control, which may enable the person to enjoy a pain-free or less painful time while experiencing PHN. Research studies offer hope for better treatments in the future.

Readers may also wish to read:

Information in this article is not intended to be medical advice. Readers should consult their healthcare provider for diagnosis, assessment, and treatment of PHN.

Sources

Department of Pain Medicine and Palliative Care web site

MayoClinic web site

National Institute of Neurological Disorders and Stroke web site

VZV Foundation web site

Katrena Wells, Photo by Cyndi Allison, All Rights Reserved

Katrena Wells - Katrena Wells is a RN in NC with 17 1/2 years of experience in oncology, an educator since 1995, and has taught exercise classes since ...

PHN Symptoms, Treatment, Research - Katrena Wells
Relaxation May Help Nerve Pain from Shingles - MyA
TENS Therapy May Help Nerve Pain - Yeza
Macrophage Research May Help People with PHN - Obli

Comments

Oct 19, 2009 6:58 AM

Guest :

The shingles is very painful and the only decent advice I can give you is to remain on the medication for as long as the pain persists. You could also try out some of the popular home remedies.

http://www.shinglesremedy.co.uk/shingles-rash.php

Oct 19, 2009 10:44 AM

Katrena Wells :

Thanks for taking the time to read and comment on this article. It sounds like you may have had some personal experience from PHN from reading your comment and I hope that if you have that you are now experiencing a full recovery or at least significant relief from the pain.

Jan 1, 2010 5:12 PM

Guest :

The article summarizes current understandings well. But, I would like more information about current research. I have phn and reoccuring bouts of the rash coming to the surface. I am 57 years old and had the first outbreak in 2005- 9 months after a stent placement. What is the incidence of shingles after stent placements? Talk about disseminated zoster, reoccuring rashes, reasons for being immunocompromised, and pain management. How can current management practices be used and someone still try to be productive and connected to life? If you take the tricyclic medication with the Lyrica- you aren't able to shake it off quickly the next morning and drive to work. Although shingles has primarily been a condition for older people who may not be working, what is the incidence of it creeping now into those of us who are in our 50's? What is the connection of the virus strain and the way it presents itself when reactivated? Is there a difference in the strain of virus prevalent in the 50's compared to the 30's? Did soldiers returning from the Korean War return with a different strain? Has this been studied?
OBTW - my first symptoms were internal (appendicitis pain and cardiovascular - heart attack symptoms) with an elevated wbc and low grade temp. Is there a connection to this type of presentation and the complications which have developed from the phn?

Jan 2, 2010 2:02 PM

Katrena Wells :

You brought up some very good points regarding my article on PHN. My article length is pretty limited on this site, so the articles are pretty narrowly focused. Keep checking my profile and I'll try to write articles on some of the topics you suggested.

It sounds like you've had a rough time with the shingles, and I feel for you in having to go through so much!

Jan 17, 2010 7:20 AM

Guest :

I'm 41, developed shingles 5/09 and have had two PHN episodes since that time, 10/09 and now 1/10. My shingles location was the left side of my face, luckily only one sore at my hairline and no ocular involvement. My question is whether there is any benefit to treatment if I can self-manage the pain until the condition subsides? I'm currently on nuerontin and find it difficult to function at work due to the sedation side effects. I'm sure that my doctor could prescribe something else, but if it isn't going to cure it, then should I bother to put chemicals in my system if I can just 'tough it out'?

Jan 18, 2010 6:48 PM

Katrena Wells :

I cannot give medical advice, but I would think it would be a wise decision to see your healthcare provider regarding PHN. Earlier treatment tends to be more effective, and there is a risk of serious complications if you have the shingles on the face. If you are experiencing side effects from the neurontin, your physician may be able to prescribe something else. I'm sorry to hear that you've had two bouts with shingles and PHN and hope you experience a full recovery.

Mar 14, 2010 2:08 PM

Guest :

I am 61 and was an active triathlete and had shingles in my left shoulder 5 months ago and recovered, however, I have since suffered with extreme hip , knee and shoulder pain and inflexibility in all major joints. Any exertion (say redecorating a room) seems to result in pain in the joints used which is out of proportion to the exertion used and takes a very long time to recover. My doctors can find nothing wrong apart from mild arthritis and say that it has nothing to do with shingles. The knee and hip pain appears to be reducing slowly and I now only have pain in the shingles affected shoulder. Have you heard of this sort of affect after shingles?
I occaisionally take a small dose of ibrprophen to manage the pain. I have now come to the conclusion of living with the pain and in some cases deliberately moving my shoulder through the range of motion which causes the pain. This seems to reduce the overall pain. I am hopeful that I will gradually recover "naturally" as there seems little other option.
However, I would be interested to know if you have heard of others suffering from whole body pain after shingles.Maybe my immune system had suffered sufficiently resulting in the sbove?
Regards,
David Barnes

Mar 14, 2010 6:16 PM

Katrena Wells :

Mr. Barnes,

It sounds like your pain has been quite difficult, especially since it has affected your active lifestyle. Appropriate range of motion exercises, if approved by a physician, may help many people. Some people can experience something called complex regional pain syndrome, in which pain seems to be much more severe than would be expected. Sometimes that one is difficult to diagnose, but early therapy tends to be particularly helpful.

Some people can have referred pain, in which pain travels to other areas of the body, like having jaw pain or arm pain with a heart attack.

It sounds like you are on the road to recovery after PHN. Maybe some others who read your message may add their own personal experiences related to PHN. It can be quite difficult to manage, and I hope that you will continue to have an improvement in symptoms.

Sep 29, 2010 9:17 AM

Guest :

I'm pushing 60 y/o. This PHN pain is the worst pain that I've experienced in my life---and I've had 4 babies and quite a few surgeries. I would gladly have 4 more babies (even at my advanced age) with nothing, zero, nada for pain if I could get rid of this pain forever. And to top it off, I keep having reoccurring bouts of shingles. I have a case right now, so I'm back on Valtrex. I'm allergic to Neurontin and Lyrica, but there are several more medications that my doctor is going to try for the nerve pain. I hope to God they work. This PHN has got to be hell or close to it. Anybody that has it certainly has my sympathy. So far, NOTHING in the PDR touches this PHN nerve pain. I may as well be eating lemon drops. PHN is the pain that keeps on giving and giving and giving...I wish that I could give it back.

Sep 30, 2010 7:46 PM

Katrena Wells :

Your vivid description of PHN ought to go in the medical books. I hope that something will be developed soon to help you if you have already been through the many options above. Chronic pain is so difficult and I'm sorry you are having to deal with this painful condition.

Oct 27, 2010 4:18 PM

Guest :

I am 27yrs old I had shimgles on my lower back when I was 20. A year later I started having pain in the area of the outbreak it has know moved down the outside of my legs and stomache where i cannot be touched, wear tight clothes or brush up against anything, without severe pain that feels like somebody beat the crap out of me then shocked me. I have tried ELAVIL, NEUROTOIN, AND MOBIC plus oxycodone 30mg and nothing touches the pain. I wish they would find something that would work.

Oct 28, 2010 4:15 AM

Katrena Wells :

Thanks so much for posting your personal experience with PHN. It sounds like you have suffered for many years with this terrible pain, and I'm sorry to hear that so many pain control measures have not worked. Some people do find success by seeing a pain specialist. I hope they will continue to study this painful condition that is so hard to treat in many people. Perhaps more options will be available soon.

Mar 27, 2011 8:48 PM

Christi B :

Recently I’ve been having odd symptoms. I’d been having paid deep in both shoulders for several months. and then I got this small bump on my R breast that itched and I thought it was a spider bite. It kept itching for days and then when I looked again it has spread to about and continued itching. When I scratched it, a scab came off and left a small hole, which made me think it was a bite and a reaction that surrounded it. But now, My left breast has the same thing and the skin on both sides itches, everywhere, but no more rashes or “bites” that I can see. I started taking protandim about 2 weeks ago and within 3 days my shoulders stopped hurting, that was a relief. I haven’t gotten any new bumps, bites or rashes either. I went to the Doctor b/c I was having an indigestion type pain and he asked if I had a rash, checking for shingles. But didn’t think much of the diminishing rash that still remained. It’s been about 3 weeks now and it’s finally clearing up. Don’t know if that will help anybody. http://www.dailylifesource.com is where you can get the Protandim. It has a master antioxidant quality about it. Good luck.

Mar 28, 2011 3:51 AM

Katrena Wells :

Posted by a member (edited to remove a link):
Recently I've been having odd symptoms. I'd been having paid deep in both shoulders for several months. and then I got this small bump on my R breast that itched and I thought it was a spider bite. It kept itching for days and then when I looked again it has spread to about and continued itching. When I scratched it, a scab came off and left a small hole, which made me think it was a bite and a reaction that surrounded it. But now, My left breast has the same thing and the skin on both sides itches, everywhere, but no more rashes or "bites" that I can see. I started taking protandim about 2 weeks ago and within 3 days my shoulders stopped hurting, that was a relief. I haven't gotten any new bumps, bites or rashes either. I went to the Doctor b/c I was having an indigestion type pain and he asked if I had a rash, checking for shingles. But didn't think much of the diminishing rash that still remained. It's been about 3 weeks now and it's finally clearing up. It has a master antioxidant quality about it. Good luck.

Katrena's Response:
Thanks so much for reading and commenting on my PHN article. I hope you will continue to recover and feel much better!

Apr 2, 2011 9:16 PM

Guest :

good article,i have 6 months pain after 5 outbreakes last year my doctor doesnt belive me,what i have to do?i am40 yold man,txs Yuriy

Apr 3, 2011 4:24 PM

Katrena Wells :

Thanks so much for reading my article and taking the time to comment. It sounds like you have had a rough six months. Unfortunately, I cannot give medical advice, but if you feel that your doctor is not listening to your concerns, you may try to find another healthcare professional that might be able to better address your concerns.

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