Postherpetic Neuralgia: Symptoms and Causes

Postherpetic neuralgia is a consequence of the herpes zoster virus infection and is a very painful condition. In this article, we'll you how it originates and the options for its treatment.
Postherpetic Neuralgia: Symptoms and Causes

Last update: 18 December, 2020

Postherpetic neuralgia is the most common complication of shingles. This relatively common viral infection in the general population doesn’t always evolve with this consequence, but when it does, it creates a big problem.

What usually happens is that a person is infected with herpes zoster or chickenpox virus. This infection can go unnoticed, it can manifest itself with the symptoms of chickenpox -especially in children- or it can be expressed with what is known as ‘shingles’.

Shingles is the first herpes zoster infection in the body. Lesions appear as small blisters on the skin following the path of the nerve where the virus is housed. The most frequent locations are the ophthalmic nerve, the trigeminal nerve in the face, and some intercostal nerves in the chest.

These blisters are accompanied by severe pain, such as a burning sensation. After a month or so, the skin lesions disappear, and little by little the pain of this first infection subsides.

The underlying problem is that the virus remains lodged in the nerve, even if it doesn’t manifest itself. Time later, some people experience a very strong pain in the same region where they had the first infection, but this time without cutaneous lesions. That’s the postherpetic neuralgia.

Those who are older, especially those over sixty, are more likely to suffer from it. Although there’s no curative treatment, measures can be taken to alleviate the symptoms.

Causes of postherpetic neuralgia

The origin of postherpetic neuralgia is clear: It’s the herpes zoster virus. The main characteristic of this microorganism is that it remains embedded in the nerves of human beings for life, even if it doesn’t manifest itself with symptoms.

When the person who has the virus inside gets older or his or her immune system becomes less active, then the disease may reactivate. The reactivation can be expressed as postherpetic neuralgia – that is, intense pain in the affected nerve.

The pain is very intense and with a burning sensation because the infected nerve is damaged. The virus destroys some nerve fibers that transmit information. With the destroyed fibers, the nervous information is confused for the brain, which interprets it as pain.

Beyond the main cause of the disease, there are risk factors that make its appearance more probable. These are:

  • Age: Above sixty years of age the frequency increases.
  • Characteristics of the initial infection: If the first appearance of herpes zoster was intense, there is more risk of subsequent neuralgia.
  • Chronic diseases: People with diabetes, for example, are more at risk.
  • Location: The face and particularly the ophthalmic area are more painful.
A woman with herpes zoster on her lips and around her mouth.
The herpes virus is the origin and cause of postherpetic neuralgia.

Symptoms of the disease

The symptom of postherpetic neuralgia is pain. It appears in a certain area that corresponds to the infected nerve. Normally, it’s an area that months or years before was affected by the blisters of the first infection.

If left to evolve alone, in most cases the pain could last six months. But in some people, without treatment, it can become an indefinite pain. There are cases in which pain can be disabling.

We could say that the three basic symptoms of the disease are as follows:

  • Pain: Intense burning, with a particular path that’s easily identifiable by the patient, which persists for months.
  • Sensitivity in the affected area. Even contact with clothing stimulates and triggers the pain.
  • Itching: The affected nerve sends confusing signals to the brain, which are interpreted as an itch in the affected territory.
A woman experiencing pain on the sider of her face.

You may also want to read: Coping with Trigeminal Neuralgia: Three Remedies

Treatment of postherpetic neuralgia

This disease has no cure. The virus will remain lodged in the nerve for the entire life of the person who possesses it. However, there are therapeutic alternatives for the treatment of pain and improvement in the quality of life.

The first step of treatment is the common non-steroidal anti-inflammatory drugs. Although in many countries these are over-the-counter, they should be prescribed by a professional, due to their possible adverse effects. The most commonly used anti-inflammatories for postherpetic neuralgia are ibuprofen and naproxen. However, people with high blood pressure, gastritis, or anticoagulants shouldn’t take them freely without supervision.

The second step of treatment is other analgesics. The simplest is acetaminophen, although the intensity of the pain can lead to the use of narcotics. In this case, obviously, only with a doctor’s prescription.

Experiments are being made with botulinum toxin, looking for treatment alternatives. The first reference to the use of this treatment is relatively recent, from the year 2002. More studies are needed, but the outlook is promising. The other two drugs that aren’t specifically analgesic, but are effective, are anticonvulsants and tricyclic antidepressants.

As a complex disease, it requires professional intervention. If you suffer from pain that you suspect could be postherpetic neuralgia, medical consultation is essential. The health team will know how to guide you with the relief measures and the type of medication you can take.

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