About Postherpetic Neuralgia
General Information
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Herpes zoster, also known as shingles, is a recurrent infection of the varicella-zoster (chickenpox) viral infection.
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The virus lies dormant within nerves until the patient's immunity wanes.
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Shingles lesions cause pain that usually goes away within a month. However, in a number of patients the pain continues chronically. Persistent pain is called postherpetic neuralgia.
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Herpes zoster infection is more common in the elderly. Half of people who reach age 80 will experience at least one attack of herpes zoster, and 50 percent of people in their 80s afflicted with herpes zoster will still have pain one year after the development of the infection.
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If the pain persists longer than one year, it is likely to become permanent.
Symptoms
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About 65 percent of patients report continuous, stabbing thoracic pain, between the neck and the abdomen.
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About 20 percent of patients report pain in the face, usually above the eyebrows.
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Other symptoms include rash, fever and general tiredness.
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The persistent, ongoing pain of postherpetic neuralgia occurs in the area of the previous rash.
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Stroking affected skin worsens the pain and applying pressure provides some relief. The rubbing of clothing is particularly painful.
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There is a higher incidence of postherpetic neuralgia in cases of herpes zoster involving the face.
Treatment
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Postherpetic neuralgia is one of the most difficult pain syndromes to treat.
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The medication amitriptyline offers relief for about 50 percent of patients. Amitriptyline enhances pain-suppressing pathways by blocking the reuptake of serotonin and norepinephrine at the neuronal synapses. Other similar medications such as imipramine, desipramine, and maprotiline may also be useful in some patients.
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Some topical remedies also exist and can provide relief in up to 40 percent of patients. Two crushed aspirin tablets dissolved in 30 ml of chloroform or diethyl ether applied two or three times a day may help the burning and stinging pain. Skin breakdown is a potential side effect.
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Surgical treatment historically has offered little relief and is used very rarely in severe cases.
The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the NeuroICU attending physician and team members direct your family member's care while in the ICU. The NeuroICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide
