Symptoms

The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred. This is most commonly in a band around your trunk, usually on just one side of your body.

They may include:

• Pain. The pain associated with postherpetic neuralgia most commonly has been described as burning, sharp and jabbing, or deep and aching.
• Sensitivity to light touch. People who have postherpetic neuralgia often cannot bear even the touch of clothing on the affected skin.
• Itching and numbness. Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.
• Weakness or paralysis. In rare cases, you might also experience muscle weakness or paralysis if the nerves involved also control muscle movement.

When to see a doctor 
See a doctor at the first sign of shingles. Often the pain starts before you notice a rash. Your risk of developing postherpetic neuralgia is cut in half if you begin taking antiviral medications within 72 hours of developing the shingles rash.

Causes

During an initial infection of chickenpox, some of the virus can remain dormant in some of your body's nerve cells. Years later, the virus may reactivate, causing shingles.

Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers aren't able to send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that may persist for months — or even years.

Preparing for your appointment

While you may initially talk to your family doctor about your signs and symptoms, he or she may refer you to a nerve specialist (neurologist) or a doctor who specializes in the treatment of chronic pain.

What you can do 
Before your appointment, you might want to write a list of answers to the following questions:

• What types of symptoms are you experiencing?
• When did these problems begin?
• Does anything make your symptoms better or worse?
• Are your symptoms interfering with daily tasks?
• What medications or dietary supplements do you take?
• What treatments have you tried in the past for this pain?

What to expect from your doctor 
During the exam, your doctor will look at your skin and ask you about your symptoms. He or she may touch your skin in different places, to determine the borders of the affected area and any changes in the sensation of touch and temperature.

He or she may ask you how the pain is affecting your enjoyment of life, your sleep and your interactions with others. Your doctor may also review in detail medications you may have tried for this pain, including the dosages and any side effects you experienced.

Tests and diagnosis

In most cases, postherpetic neuralgia can be diagnosed during the office exam. No tests are usually necessary.

Treatment and drugs

There is no single treatment that relieves postherpetic neuralgia in all people. In many cases, it may take a combination of treatments to reduce the pain.

Lidocaine skin patches 
These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. These patches can be cut to fit only the affected area. You apply the patches, available by prescription, directly to painful skin to deliver temporary relief.

Tricyclic antidepressants 
Antidepressants such as nortriptyline and amitriptyline affect key brain chemicals 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.

Certain anticonvulsants 
Anti-seizure medications also can lessen the pain associated with postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Doctors may prescribe gabapentin (Neurontin), pregabalin (Lyrica) or another anticonvulsant to help control burning and pain.

Opioid painkillers 
Some people may need prescription-strength pain medications containing tramadol (Ultram, Ryzolt), oxycodone (Percocet) or morphine. However, these drugs can be addictive. Although this risk is generally low, discuss it with your doctor.

Lifestyle and home remedies

You may find that the following over-the-counter medications ease the pain of postherpetic neuralgia:

• Capsaicin. Capsaicin cream, made from the seeds of hot chili peppers, may relieve pain from postherpetic neuralgia. Capsaicin (Capzasin-P, Zostrix) can cause a burning sensation and irritate your skin, but these side effects usually disappear over time. Capsaicin cream can be very irritating if rubbed on unaffected parts of your body, such as in your eyes. Follow the application instructions carefully, including wearing gloves for application and washing your hands thoroughly after applying.
• Topical analgesics and anesthetics. Aspirin mixed into an absorbing cream or nonprescription-strength lidocaine cream may reduce skin hypersensitivity.

Prevetion

The varicella-zoster vaccine (Zostavax) can help prevent shingles and subsequent postherpetic neuralgia in adults age 60 and older.