Shingles & Post-Herpetic Neuralgia
Prevention and treatment of shingles complications
Understanding Shingles & Post-Herpetic Neuralgia
Shingles is a viral infection caused by reactivation of the varicella-zoster virus—the same virus that causes chickenpox. Post-herpetic neuralgia (PHN) is the most common complication, defined as pain persisting for more than 90 days after the onset of the rash. It affects 10-18% of shingles patients overall, but the risk increases significantly with age.
PHN results from nerve damage caused by the viral infection and inflammation, leading to abnormal pain signal processing. The pain can be severe and debilitating, significantly impacting quality of life. Early antiviral treatment of shingles can reduce the risk and severity of PHN. Prevention through vaccination is highly effective.
Common Causes
Varicella-Zoster Virus Reactivation
Dormant virus becoming active due to weakened immunity
Age-Related Immune Decline
Risk increases significantly after age 50
Immunosuppression
Conditions or medications weakening the immune system
Stress or Illness
Physical or emotional stress triggering viral reactivation
Nerve Damage from Acute Infection
Viral inflammation causing lasting nerve injury leading to PHN
Delayed Antiviral Treatment
Increasing risk of complications including PHN
Symptoms
Painful, burning rash with fluid-filled blisters
Persistent burning or stabbing pain (PHN)
Extreme sensitivity to touch (allodynia)
Itching or numbness in affected area
Sharp, shooting, or electric shock-like pain
Headache and fatigue
Sensitivity to temperature changes
Sleep disturbance and depression from chronic pain
Advanced Treatment Options
Early Antiviral Therapy
Acyclovir, valacyclovir, or famciclovir started within 72 hours to reduce PHN risk
Nerve Blocks
Sympathetic blocks or epidural injections during acute phase may prevent PHN
Topical Treatments
High-concentration capsaicin patches (8%) or lidocaine patches for localized pain
Spinal Cord Stimulation
For severe, refractory PHN not responding to conservative treatments
Intrathecal Drug Delivery
Implanted pumps for severe, widespread PHN pain
Pulsed Radiofrequency
Non-destructive nerve modulation for affected dorsal root ganglia
Preventive Vaccination
Shingrix vaccine reducing shingles risk by over 90%
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