1. What is Post-Herpetic Neuralgia (PHN)?
Postherpetic neuralgia (post-her-PET-ic noo-RAL-jah or PHN) is a painful condition affecting your nerve fibers and skin. PHN is a complication of shingles. A second outbreak of the varicella-zoster virus, which initially causes chickenpox, is responsible for shingles.
Following an initial chickenpox infection, some of the virus may remain dormant inside nerve cells. Factors such as age, illness, stress, or medications can reactivate the virus years later, causing shingles. The virus can also reactivate for no apparent reason.
The reactivated virus travels along nerve fibers, causing pain. When the virus reaches the skin, a rash and blisters form. Most cases of shingles (herpes zoster) heal within a month. Some people continue to feel pain for months or even years after the rash and blisters heal. This pain is known as postherpetic neuralgia. PHN is defined as pain persisting for more than a month after resolution of the herpes zoster rash.
PHN does not occur in all shingles cases. A person’s likelihood of developing PHN from shingles increases with age, however.
2. What causes PHN?
PHN is nerve pain resulting from a nerve that is irritated or inflamed. The pain spreads and may be fleeting or chronic, and can range widely in severity. When nerve fibers are damaged during an outbreak of shingles, they are not able to send messages as they normally do. The body perceives these "mixed messages" as pain.
3. What are the symptoms of PHN?
Most people experience PHN as a continuous burning sensation, but pain may also be very severe and unrelenting. The pain of PHN may be sharp, piercing, throbbing or stabbing and may result in intolerable skin sensitivity to even the lightest touch.
4. What treatment options exist for PHN?
For most people who develop PHN, the pain will gradually resolve with time. The focus of treatment is to control pain while waiting for the condition to resolve. Pain therapy may include topical medications, over-the-counter analgesics, tricyclic antidepressants, anticonvulsants and several nonmedical modalities. Narcotics may also be required.
Classes of medications used to treat PHN:
- Analgesics (capsaicin, Lidocaine Patches, acetaminophen)
- Tricyclic Antidepressants
- Anticonvulsants
Effective treatment of postherpetic neuralgia often requires multiple treatment approaches. In addition to medications, modalities to consider include transcutaneous electric nerve stimulation (TENS), biofeedback and nerve blocks.
Additional Resources
http://www.mayoclinic.com/health/postherpetic-neuralgia/DS00277
http://www.aafp.org/afp/20000415/2437.html
http://www.aftershingles.com/phn.html
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