FAQs on Post Herpetic Neuralgia Treatment in Philadelphia

Post herpetic neuralgia (PHN) occurs after a severe case of shingles (herpes zoster). This condition affects the nerves and results in nerve pain (neuropathy). Herpes zoster is a virus that attacks the central and peripheral nervous system. This virus affects a single nerve root, which causes a painful rash. When the rash heals and pain persists, this is known as PHN.

What causes post herpetic neuralgia?

When the herpes zoster virus travels from the nerve on the spinal cord and down the spinal nerve, a painful rash erupts on the skin. The trunk is the most common site for shingles. The virus travels along a dermatone (area of the skin supplied by only one nerve). When attacking the skin, the virus causes local nerve tissue swelling and reduced blood flow. If the nerve is permanently damaged, PHN occurs, making the skin extremely painful and sensitive.

How common is herpes zoster?

Herpes zoster affects around 3 people out of every 1,000 persons. Around half of the people who develop PHN are between the ages of 50 and 70 years of age.

What are the symptoms of PHN?

Acute herpes zoster will lead to watery, blisters, painful lesions, and skin sensitivity. Once the rash fades, patients with PHN often experience hyperalgia (extreme skin sensitivity to wind, light touch, or cloth). Other symptoms associated with PHN include joint pain and muscle tenderness.

What are the treatment options for someone with post herpetic neuralgia?

The treatment of post herpetic neuralgia depends on the severity of the condition. The pain management specialist often uses a combination of therapies to treat PHN. These include:

  • Antiviral medications – To reduce the severity of the herpes zoster, antiviral agents are prescribed, such as famcyclovir (Famvir) and acyclovir (Zovirax). If used early on, these reduce the severity of PHN.

 

  • Pain medications – Neuropathic pain is treated with amitriptyline, paracetamol, and narcotic analgesics. Corticosteroid drugs are used short-term. Anticonvulsants (gabapentin and pregabalin) are often used, as well.

 

  • Topical agents – Many patients find relief of pain with topical agents, such as capsaicin, lidocaine pain patches (Lidoderm), and topical menthol.

 

  • Acupuncture – For chronic neuropathic pain, the doctor may recommend acupuncture. With this therapy, the practitioner inserts tiny needles into acupoints along the body. This helps restore body energy and stimulates endorphin release.

 

  • Sympathetic nerve blocks – Using x-ray guidance to assure needle placement, the doctor inserts a needle near the affected nerves and delivers a long-acting anesthetic. This blocks pain signals. A recent study found that use of bupivacaine and clonidine in this block helped patients remain pain-free for up to eight months.

 

  • Epidural steroid injection (ESI) – This involves the use of a corticosteroid injected into the epidural space to alleviate inflammation, and for further pain relief, a long-acting steroid may be added. Research reports have proven that ESI alleviates PHN pain.

 

  • Pulsed radiofrequency lesioning (PRF) – This treatment is used to destroy a portion of a nerve root. A recent study found that PHN offers more than 55% pain relief that lasted for up to 12 weeks. According to a clinical study, the efficacy rate for PRF is around 80%.

 

  • Self-help measures – There are some things you can do to relieve the pain associated with PHN. Avoid clothes that are too tight or made of synthetic, rough materials. These irritate the skin and make the condition worse. In addition, cover the sensitive areas with plastic would dressings or cling film. Gel-filled cold packs will numb the painful areas and are useful for PHN.

Resources

Dubinsky, RM et al. (2004). Treatment of postherpetic neuralgia: An evidence-based report. Neurology, 63, 959-965.

Kim, YH et al. (2003). Effect of pulsed radiofrequency for postherpetic neuralgia. Acta Anesthesiology Scand, 52, 1140-1143.

Schmader KE (2002). Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clinical Journal of Pain, 18(6), 350-354.