What is Shingles Pain (Post herpetic neuralgia – PHN)?

The Golden Girl, Rue McClanahan bravely fought PHN for several years and joined an awareness campaign for the condition before losing the battle at the age of 76 yrs. Source: zap.it.com

Shingles, according to Dr. Karl R Beutner, MD, PhD, is a highly underrated disease and making the public aware of its causes, symptoms and treatment plays an important in its management (read about Anne Heche’s and Robin William’s struggle with this disease) . Hence, to address this issue, I have come with a series of posts that will give you information about all the different aspects of Shingles. I will be starting this series with my post on “What is Shingles pain?”

By definition, Shingles pain, also known as Chronic Shingles pain or Post Herpetic Neuralgia is the pain (often described as a tingling, creepy-crawly pain like sensation) that accompanies the shingles rash and persists for a minimum of 4 months even after the rash has resolved.

To explain this in more detail, Shingles is a viral infection of the nerve endings caused by the virus, Varicella Zoster – the same virus that causes chickenpox in childhood. Now, once exposed to the virus (either through infection or chickenpox vaccine), the virus never gets eliminated from the body, rather it lingers in the nerve cells of the body, albeit in a dormant form for ages.

However, at times, during periods of lowered immunity, the virus can get reactivated and cause localized skin rash (unlike the generalized rash associated with chickenpox) and neurologic changes in the nerve endings that results in continued excitation of pain receptors – a condition known as neuralgia. This pain is generally localized in the area of the shingles rash and usually resolves once the rash heals. However, in some cases the pain lingers on and can last for several months or even years, irrespective of the crusting or healing of the rash, such cases are termed as chronic shingles pain, post herpetic neuralgia or just PHN. The severity of the Shingles pain may vary from a feeling of discomfort to a burning, stabbing, or gnawing pain in the area affected.

Who is susceptible?

Everybody who has been exposed to the varicella zoster virus, either in form of chickenpox infection, chickenpox vaccine, or a previously resolved episode of Shingles are susceptible to Shingles pain.

What are the signs and symptoms of PHN?

Shingles pain is usually preceded by the Shingles rash, which is characterized by a band like rash that appears on the side of the body. Headache, photo-sensitivity, Flu like symptoms without fever, followed by itching, tingling, discomfort, and pain are the classic sings of Singles developing into Post Herpetic Neuralgia.

How long will the Shingles Pain last?

The Shingles pain subsides soon after the rash resolves in some people, where as in others the pain can last of several weeks, moths, and even years after the rash resolves. The reason for this is as yet unknowns, however, if the pain lasts for more than 4 months then the Shingles pain is termed as Post Herpetic Neuralgia or PHN.

What is the treatment for PHN?

The treatment for PHN usually involves administration of antiviral agents to check the viral activity along with other pain relieving drugs like analgesics, NSAIDs, and opioids, and drugs like corticosteroids, antidepressants, and anti-convulsants to treat the neuralgia. Topical ointments and calmative agents may also be prescribed to sooth the irritation at the site of rash.

New treatments are being investigated in clinical trials for the treatment of PHN in patients who have had the pain for more than 6 months

Where can I get further information on PHN?

Do refer to the various articles on Shingles and PHN posted on our site for further information on the treatment options and recent developments in the field of Shingles pain and PHN.

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