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Post-herpetic neuralgia

Post-herpetic neuralgia is a form of persistent pain after an attack of shingles. Pain can affect any part of the body that was affected by shingles, including the face. The type of pain that occurs with post-herpetic neuralgia is called neuropathic pain because it involves the nerves.

People with post-herpetic neuralgia usually experience a burning, aching or throbbing pain that is often accompanied by extreme tenderness. They might find that the wind blowing against their face or the brush of clothing or bedclothes is unbearable. Although people experience extreme tenderness in the affected areas, the general sensitivity of their skin may be reduced.

What is shingles?

The medical name for shingles is herpes zoster. Shingles is caused by the chickenpox virus which most people get as a child. Shingles usually affects older people. It occurs when the virus, which has been in the body for many years without causing any symptoms, begins to flare up again and attacks one of the nerves in the skin. It most commonly affects a nerve on the upper body but it can affect nerves in the head and face. It only ever affects one side of the face.

Shingles can begin with a dull pain or a burning or tingling sensation in the skin. For most people, this is followed a few days later by a weeping rash. The rash usually clears up within a few weeks. This can be helped by certain drugs, such as acyclovir. Some people are left with scarring but the majority of people find that the pain settles down and the rash disappears without leaving any scars.

How does shingles cause post-herpetic neuralgia?

The virus damages the nerve and so the area of skin served by that nerve goes partly numb. People may experience pain in this area. The pain happens because the nerve continues to send signals to the brain that result in pain.

Who gets post-herpetic neuralgia?

Anyone who has had shingles can get post-herpetic neuralgia, although it is very rare in younger adults. Post-herpetic neuralgia mainly occurs in people aged 65 years and older. Approximately one in five people who have shingles will continue to experience pain after the rash has healed. Only a small number of these people will develop the condition in the face.

What are the treatments for post-herpetic neuralgia?

If people are still experiencing face pain a month after the shingles rash has disappeared their GP may prescribe medication. This is because medication is more effective when it is taken in the early stages of post-herpetic neuralgia. Ordinary pain relief drugs usually have very little effect on post-herpetic neuralgia.

The main drugs used to treat post-herpetic neuralgia are gabapentin, amitriptyline or nortriptyline. These drugs have been used to treat depression and epilepsy but they can have a very powerful effect on certain forms of nerve pain. It might take two to three weeks before they begin to provide any pain reduction. People might be given a low dose to start with that is gradually increased, and may need to take these drugs for several months.

Other medicines prescribed to treat post-herpetic neuralgia include the anticonvulsants gabapentin and pregablin. Some people find creams, lotions and patches helpful. These act as local anaesthetics and numb the area. The patches (e.g. Versatis) contain an anaesthetic (for example, lidocaine) and can be applied for 12 hours at a time. The patches look like plasters.

Surgical procedures to interrupt the nerve (used to treat people with trigeminal neuralgia) are never effective in the treatment of post-herpetic neuralgia.

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