Postherpetic Neuralgia (Shingles)

Shingles (postherpetic neuralgia) is an increasingly common condition that parallels the aging of our population.  Simply put, shingles is the recurrence of chicken pox in the adult typically after the age of 75 or 80, but we certainly will see 30 and 40-year-olds with it.  Although they may not always remember having had chicken pox, in fact almost universally were exposed to the virus and it remains in our bodies thereafter.  It is believed that it remains in the central nervous system, brain, and spinal cord, and is kept under check by the immune system.  For reasons not fully understood, as we get older our ability to maintain control over the virus decreases and at some point, in a significant number of patients, it comes out as a rash in 1 or 2 specific areas of skin called dermatomes.  This could be anywhere from the top of the head to the tips of the toes, and can be excruciatingly painful.  It is very important that patients seek immediate medical attention so that antiviral medications and medications to reduce the inflammation can be started.  This should be done within a day or two of the rash, and certainly no more than a week after.  Typically, the rash lasts for a few weeks and clears.  The pain itself may or may not subside.  For the group of patients in whom the pain does not subside, we refer to that as postherpetic neuralgia, and it can occur in anywhere from 20% to as much as 40% of the population that experiences shingles.

The pain of persistent shingles has been described as one of the most severe known to medicine.  It can be very disabling and needs careful and thoughtful management.  Medications specifically addressing the underlying irritation of nerve tissue are available, and they should be used early in order to prevent or minimize chronic pain developing.  Because even with best available care many patients continue to have difficulty, active research is being conducted in this field at ours and many other clinical centers.  Part of that research led to the development of a shingles vaccine, which is helpful in reducing the risk of developing shingles in those who have not had it.  But, unfortunately it is not helpful once you do develop the condition.

For information on this and many other chronic pain conditions, feel free to contact our treatment team and our research department.

1 Comment
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