Diseases & Conditions
neuralgia is a painful condition affecting your
nerve fibers and skin. It's a complication of
shingles, a second outbreak of the varicella-zoster
virus, which initially causes chickenpox.
During an initial infection of
of the chickenpox virus can remain in your system,
lying dormant inside nerve cells. Years later,
factors such as age, illness, stress or medications
can reactivate the virus. It can also reactivate for
no apparent reason.
Once reactivated, the virus travels along nerve
fibers, causing pain. When the virus reaches the
skin, it produces a rash and blisters, known as
shingles (herpes zoster). A case of
heals within a month. But some people continue to
feel pain long after the rash and blisters heal.
This pain is known as postherpetic neuralgia.
Treatment for postherpetic neuralgia also depends on the type of pain
you experience. Possible options include:
These are small, bandage-like patches that contain the topical,
pain-relieving medication lidocaine. You apply the patches,
available by prescription, directly to painful skin to deliver
relief for four to 12 hours. Don't use patches containing lidocaine
on your face.
These drugs affect key brain chemicals, including serotonin and
norepinephrine, that play a role in both depression and how your
body interprets pain. Doctors typically prescribe antidepressants
for postherpetic neuralgia in smaller doses than they do for
depression. Tricyclic antidepressants, including amitriptyline (Elavil),
seem to work best for deep, aching pain. They don't eliminate the
pain, but they may make it easier to tolerate. Other prescription
antidepressants for postherpetic neuralgia include venlafaxine (Effexor),
bupropion (Wellbutrin) and selective serotonin reuptake inhibitors
such as sertraline (Zoloft), paroxetine (Paxil) and fluoxetine
Medications such as phenytoin (Dilantin, Phenytek), used to treat
seizures, also can lessen the pain associated with postherpetic
neuralgia. The medications stabilize abnormal electrical activity in
your nervous system caused by injured nerves. Doctors often
prescribe another anticonvulsant called carbamazepine (Carbatrol,
Tegretol) for sharp, jabbing pain. Newer anticonvulsants, such as
gabapentin (Neurontin) and lamotrigine (Lamictal), are generally
tolerated better and can help control burning and pain.
Some people may need prescription-strength pain medications, such as
tramadol (Ultram) or fentanyl (Duragesic), to control their pain.
However, these drugs are narcotics and can be addictive.
electrical nerve stimulation (TENS).
This treatment involves the placement of electrodes over the painful
area. The electrodes are then attached to a small, portable
stimulator that you wear. The stimulator delivers tiny, painless
electrical impulses that pass through the electrodes to nearby nerve
pathways. You turn the TENS unit on and off as needed to control
pain. Exactly how the impulses relieve pain is uncertain. One theory
is that the impulses stimulate production of endorphins, your body's
In some cases, treatment of postherpetic neuralgia brings complete pain
relief. But most people still experience some pain, and a few don't
receive any relief. Although some people must live with postherpetic
neuralgia the rest of their lives, most people can expect the condition
to gradually disappear on its own within five years.
Postherpetic neuralgia >