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Postherpetic Neuralgia

By

Kenneth M. Kaye

, MD, Brigham and Women’s Hospital, Harvard Medical School

Last full review/revision Apr 2020| Content last modified Apr 2020
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Postherpetic neuralgia is chronic pain in areas of skin supplied by nerves infected with herpes zoster (shingles).

Shingles is a painful rash of fluid-filled blisters that is caused by reactivation of the varicella-zoster virus, the virus that causes chickenpox. The varicella-zoster virus is a member of the herpesvirus family (herpesvirus type 3). Shingles is sometimes called herpes zoster. Some people who have had shingles continue to have pain long after the rash has gone away. Such pain is called postherpetic neuralgia, which means nerve pain after herpes.

Exactly why postherpetic neuralgia occurs is not well-understood.

Postherpetic neuralgia occurs most often in older people. As people age, the chance of developing postherpetic neuralgia increases.

Symptoms

The pain of postherpetic neuralgia occurs in the area where the shingles rash occurred. The pain may be constant or intermittent. The pain may be severe and even incapacitating.

The pain may subside within several months but may persist for years.

Diagnosis

  • A doctor's evaluation

If people who have had shingles continue to have pain in the area affected by shingles, they should see a doctor.

Postherpetic neuralgia diagnosis is usually based on symptoms and results of a physical examination in people who have had shingles.

Treatment

  • Pain-relieving drugs or creams

  • Sometimes other drugs

Although a number of treatments for severe postherpetic neuralgia have been tried, no treatment is routinely successful.

Postherpetic neuralgia treatments may include

  • Certain antiseizure drugs (such as gabapentin and pregabalin)

  • Certain antidepressants (such as amitriptyline)

  • Topical lidocaine ointment

  • Sometimes opioids

  • Botulinum toxin A injected into the affected area, which may reduce the pain

Drugs Mentioned In This Article

Generic Name Select Brand Names
No US brand name
LYRICA
NEURONTIN
XYLOCAINE
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