Principles of PHN

Posted: May 22, 2018 Author: Patti Dipanfilo

Each year, about one million Americans are affected by shingles, that itchy, burning, blistery and usually very painful rash that can break out anywhere on your body. Shingles is caused by the herpes virus, varicella-zoster, the same bug that causes chickenpox.

So, if you’ve had chickenpox as a kid, that nasty virus can hang around inside your body, hiding in the nerves, and show up again later as shingles. This sneaky germ can lie dormant for decades before reactivating and causing shingles.

For many people who get shingles, the symptoms last from two to six weeks then go away, and you feel better. But an estimated one out of five people ends up with continuing pain after the shingles bout is over. The technical name for this pain complication is postherpetic neuralgia or PHN.

PHN is the result of the virus damaging the nerves of the tissues at the rash site. It’s thought to affect the proper functioning of the nerves that register sensations such as pain, pressure and touch. PHN pain can be rather mild, or it can be excruciating, prompted by the slightest stimulation, such as the touch of clothing or a breeze over the skin.

PHN pain can go away after one month or persist for months and even years after the shingles rash has gone away. No one knows why PHN goes away rather quickly in some people and lasts a long time in others.

There are several factors that increase your risk for getting PHN. They include older age, gender (the risk for longer-lasting PHN is higher in women) and having had shingles that affected the eyes. Having a family history of PHN also puts you at increased risk for developing the painful complication.

Most of the symptoms of PHN occur at the site of the original shingles rash. Some of the things to look out for include an occasional burning, shooting pain and a constant throbbing or aching pain. You may also feel extreme sensitivity to touch and/or temperature. Itching and numbness at the rash site also may occur.

If the nerves that control muscle movement are affected by the PHN, you could experience muscle weakness and even paralysis. Fortunately, this is rare.

Treatment for PHN is not the same for everybody. It is tailored to your specific symptoms and response to medications. There are several types of medications used to treat PHN pain. Your doctor may refer you to a pain management specialist to determine the right medication or combination of treatments that works best for you.

Some of the common medication treatments used for PHN include:

  • Lidocaine or capsaicin pain patches are applied directly to the skin.
  • Pain medications may include non-opioid and opioid drugs.
  • Antidepressants in lower doses than used to treat depression have been shown to help relieve pain.
  • Anticonvulsants traditionally used to treat seizures stabilize abnormal activity of the nerves.

Some people find transcutaneous electrical nerve stimulation, or TENS, beneficial for reducing the pain of PHN. Its effectiveness has not been proven through research, however.

Some experts believe that PHN can be prevented or its impact lessened if you’re treated with antiviral medication soon after your shingles is diagnosed. Others say the research doesn’t bear this out. Still, it’s often used as a therapy to shorten the course of the shingles outbreak and, hopefully, avoid PHN.

The best way to protect yourself against PHN is to get vaccinated against chickenpox, if you’ve never been, and especially against shingles. The shingles vaccine is not 100 percent effective, but it can greatly reduce the chance of getting the disease and its complications, including PHN.

It is recommended that everyone 50 and older, especially those over 60, get the shingles vaccine to help protect them against an outbreak of shingles and resulting PHN. It’s a little step. You can get the shot at most pharmacies, so it’s readily available.

It’s better to take a few minutes to get a quick shot in the arm than to risk spending months or years in horrible pain. It’s really an easy decision!

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