Post-Herpetic Neuralgia

Defining Post-Herpetic Neuralgia

Post-herpetic neuralgia is a complication of shingles, which is caused by the varicella-zoster virus, the same virus that causes chickenpox.

After you recover from chickenpox, the virus remains dormant in the nervous system. However, in some individuals, the virus can reactivate later in life, typically manifesting as shingles (herpes zoster).

During a shingles outbreak, the virus causes a painful rash that usually develops on one side of your body.

While the rash and other symptoms of shingles usually resolve within a few weeks, some individuals continue to experience persistent pain in the affected area even after the rash has healed.

This lingering pain is known as post-herpetic neuralgia.

Post-herpetic neuralgia is characterised by persistent, severe pain that persists for weeks, months, or even years after the shingles rash has healed. 

The pain from post-herpetic neuralgia is often described as burning, stabbing, or shooting and can be debilitating, affecting daily activities, sleep, and overall quality of life.

It typically occurs in the area where the shingles rash was present but can also radiate to nearby areas.

Where Does Post-Herpetic Neuralgia Occur?

Post-herpetic neuralgia pain typically occurs in the area where a shingles rash previously appeared.

Shingles typically affects one side of the body and usually manifests as a painful rash that develops in a band-like pattern, often wrapping around the torso, although it can occur in other areas as well.

Once the shingles rash heals, some individuals may continue to experience persistent pain in the same area.

This lingering pain characterises post-herpetic neuralgia.

The pain associated with post-herpetic neuralgia can be chronic and severe, described as burning, stabbing, or shooting, and may last for weeks, months, or even years after the shingles rash has healed.

While the pain of post-herpetic neuralgia primarily affects the area where the shingles rash occurred, it can also radiate to nearby areas or affect larger areas of the body, depending on your individual circumstances.

The severity and distribution of pain can vary amongst patients suffering from post-herpetic neuralgia. 

What Causes Post-Herpetic Neuralgia?

The exact cause of postherpetic neuralgia is not fully understood, but it is believed to result from nerve damage or inflammation caused by the varicella-zoster virus during the shingles infection. 

Factors such as age, the severity of the shingles rash, and underlying health conditions may increase the risk of developing postherpetic neuralgia.

What is a Post-Herpetic Neuralgia Specialist?

A post-herpetic neuralgia specialist is a healthcare professional with expertise in diagnosing and managing the type of chronic pain that persists after a shingles outbreak. 

Typically, a post-herpetic neuralgia specialist is either a pain management physician, a neurologist, or a combination of both, who focuses on providing tailored treatment plans to alleviate pain, improve function, and enhance the quality of life for individuals living with this condition. 

They may utilise a variety of approaches, including medications, nerve blocks, physical therapy, and psychological support, to address the multifaceted aspects of post-herpetic neuralgia and often collaborate with other medical professionals to provide holistic pain management care. 

Multidisciplinary Teams for Post-Herpetic Neuralgia

Post-herpetic neuralgia is often best treated by a multidisciplinary team who takes a holistic approach to managing your condition.

The types of specialists involved typically include:

• Pain Management Specialists. Physicians who specialise in managing chronic pain conditions, including post-herpetic neuralgia. They have expertise in prescribing medications, performing nerve blocks, and employing other interventional techniques to alleviate pain.
• Neurologists. Doctors who specialise in diagnosing and treating disorders of the nervous system. Neurologists can provide expertise in understanding the underlying neurological mechanisms of post-herpetic neuralgia and managing symptoms with medications or other treatments.
• Physical Therapists. Healthcare professionals who specialise in rehabilitative exercises, manual therapy techniques, and other modalities to improve function and reduce pain in individuals with post-herpetic neuralgia.
• Psychiatrists or Psychologists. Mental health professionals who can help individuals cope with the emotional and psychological impact of living with chronic pain. They provide counselling, support, and coping strategies to manage stress, anxiety, depression, and other mental health concerns associated with this condition.
• Anaesthetists. Physicians who specialise in pain management techniques, including nerve blocks, epidural injections, and other procedures to alleviate pain associated with post-herpetic neuralgia.

A pain specialist who treats post-herpetic neuralgia often consults with the aforementioned types of healthcare professionals or works as part of a multidisciplinary team, collaborating with other specialists to provide comprehensive care tailored to the individual’s needs. 

It’s essential for individuals living with post-herpetic neuralgia to seek care from physicians like Dr Mittal who has significant experience and expertise in managing chronic pain conditions in order to ensure optimal treatment outcomes.

How Does a Pain Specialist Treat Post-Herpetic Neuralgia?

Treatment for post-herpetic neuralgia aims to relieve pain and improve quality of life.

This may include medications such as anticonvulsants, antidepressants, topical treatments, nerve blocks, physical therapy, psychological therapy and in some cases, advanced therapies such as neuromodulation.

Early diagnosis and prompt treatment of shingles may help reduce the risk of developing post-herpetic neuralgia.

What Does a Treatment Plan for Post-Herpetic Neuralgia Involve?

Several methods and techniques can be used to treat post-herpetic neuralgia, often in combination. These include (but are not limited to):

• Medications. Various medications can help manage the pain associated with this condition. These may include anticonvulsants such as gabapentin or pregabalin, tricyclic antidepressants such as amitriptyline, and topical treatments like lignocaine patches.
• Nerve Blocks. Nerve blocks involve injecting a local anaesthetic, often combined with a corticosteroid, directly into the affected nerves to block pain signals and reduce inflammation. These may be followed by pulsed radiofrequency denervation therapy to minimise the intensity of the pain from post herpetic neuralgia.
• Transcutaneous Electrical Nerve Stimulation (TENS). TENS therapy involves applying mild electrical stimulation to the skin over the painful area, which can help disrupt pain signals and provide relief for some individuals with post-herpetic neuralgia. 
• Physical Therapy. Physical therapy can play a crucial role in managing post-herpetic neuralgia by improving posture, flexibility, and strength, as well as reducing muscle tension and promoting relaxation. Techniques such as massage, stretching, and exercise may be beneficial.
• Psychological Support. Psychological interventions such as cognitive-behavioural therapy (CBT) or mindfulness-based stress reduction (MBSR) can help individuals with post-herpetic neuralgia to better cope with pain, reduce stress, and improve mood and quality of life.
• Surgical Interventions. In rare cases where other treatments are ineffective, surgical options such as spinal cord or dorsal root ganglion stimulation may be considered for individuals with severe and refractory variations of neuralgia. 

Treatment for post-herpetic neuralgia should be individualised, and a combination of approaches may be necessary to achieve optimal pain relief and improve quality of life.

If you are suffering from post-herpetic neuralgia, it is essential for you to work closely with healthcare providers to develop a comprehensive treatment plan tailored to your specific needs and preferences.

The Challenges of Living With Post-Herpetic Neuralgia

Living with post-herpetic neuralgia presents many difficulties, including:

• Chronic Pain. Post-herpetic neuralgia is characterised by persistent and often severe pain in the area where the shingles rash previously appeared. Coping with chronic pain can significantly impact daily activities, work, and overall quality of life.
• Disruption of Daily Activities. The ongoing pain associated with post-herpetic neuralgia can make it difficult to perform routine tasks such as working, exercising, or even engaging in leisure activities. Individuals may experience limitations in their ability to move, sleep, or concentrate due to the constant discomfort.
• Emotional and Psychological Impact. Living with chronic pain can lead to emotional distress, anxiety, depression, and frustration. Coping with the unpredictability of pain episodes and the impact on daily life can take a toll on mental well-being and overall emotional health.
• Sleep Disturbances. Persistent pain from post-herpetic neuralgia can interfere with sleep, leading to insomnia or poor sleep quality. Lack of restorative sleep can exacerbate pain sensitivity and contribute to fatigue, mood disturbances, and decreased overall functioning.
• Social Isolation. Individuals with post-herpetic neuralgia may withdraw from social activities or avoid social interactions due to pain and discomfort. Feelings of isolation or loneliness can further worsen emotional well-being and impact relationships with family and friends.
• Financial Burden. Managing post-herpetic neuralgia often involves ongoing medical appointments, treatments, medications, and possibly even surgical interventions. The financial costs associated with healthcare expenses and missed workdays, can add stress and strain for patients and their families.
• Limited Treatment Options. While various treatment options are available for post-herpetic neuralgia, finding effective pain relief can be challenging. Some individuals may require multiple medications or combinations of treatments to achieve adequate pain control, and not all treatments are equally effective for everyone.
• Poor Quality of Life. The combination of chronic pain, emotional distress, sleep disturbances, and limitations in daily activities can significantly impact an individual’s overall quality of life. Finding ways to manage pain, cope with emotional challenges, and maintain social connections are essential for improving quality of life for individuals living with post-herpetic neuralgia. 

Overall, living with post-herpetic neuralgia can be physically and emotionally challenging as well as socially isolating, requiring comprehensive support, coping strategies, and access to appropriate medical care to manage the condition effectively.

How Do I Find a Post-Herpetic Neuralgia Pain Specialist Near Me?

Finding a post-herpetic neuralgia specialist in your area is the first step towards improving your life while living with this medical condition.

To find a post-herpetic neuralgia specialist in or around Melbourne, you can start by asking your general practitioner for referrals to a pain management doctor or team, ideally one with significant local experience and expertise when treating patients with post-herpetic neuralgia. 

Also, reach out to  friends, family, and even support groups for post-herpetic neuralgia (both online or in-person) for referrals to physicians they’ve had positive experiences with. 

Persistent Pain Solutions for Post-Herpetic Neuralgia

Dr Mittal and her collaborative multidisciplinary team offer compassionate care to every chronic pain patient who walks into the Persistent Pain Solutions Clinic. 

Post-herpetic neuralgia or other chronic pain conditions have a major impact on individuals as well as their friends and family — but there are solutions to help manage your pain more effectively.

The Persistent Pain Solutions clinic is a place of healing and comfort where your concerns and needs are first and foremost. Dr Mittal offers empathy, understanding, and support for you and your loved ones.  

Compassion is essential to healing, after all, and Dr Mittal is dedicated to guiding you towards relief from occipital neuralgia and restoring your ability to enjoy your daily routine and a higher quality of life.