FAQs on Post Herpetic Neuralgia Treatment in Las Vegas

Post herpetic neuralgia (PHN) is a condition directly related to herpes zoster (shingles). The herpes zoster virus attacks the peripheral and central nervous system, causing a painful rash due to the affected single nerve root. When a rash heals, and the pain continues, it is known as PHN.

Is post herpetic neuralgia common?

According to research, herpes zoster affects 3 out of every 1,000 people in the U.S. Approximately 50% of those who develop PHN are 50-70 years of age. Around 5% of people with shingles have pain three months after the rash clears, and at one year, around 3% have PHN.

What are the symptoms of PHN?

Acute herpes zoster causes painful, watery blisters and skin sensitivity. After the rash resolves, many patients continue to have skin sensitivity to light touch, wind, and even clothing. Many patients with PHN also have muscle tenderness and joint pain.

What is the cause of post herpetic neuralgia?

A painful rash erupts on the skin when the herpes zoster virus moves along the nerve. The most common site for shingles is the abdomen/chest region. The virus also causes local nerve tissue swelling and reduction of blood flow. When the nerve is permanently damaged from this mechanism, the skin remains sensitive and painful.

How is post herpetic neuralgia treated?

Some treatment options for PHN are often combined to offer the best therapy. The pain specialist treats the pain based on severity, frequency, and duration. Options include:

  • Pain medications – Topical agents are often used because they provide quick-acting pain relief. These include Lidoderm (anesthetic patch), capsaicin, and salicylates. For neuropathic (nerve) pain, antidepressants are used, such as amitriptyline and nortriptyline. In addition, anticonvulsants are prescribed, such as pregabalin and gabapentin.

 

  • Antiviral medications – To reduce the severity of a herpes zoster virus, many antiviral agents can be prescribed. These include Famvir and Zovirax. When used early on in a shingles outbreak, these agents can prevent or reduce the severity of PHN.

 

  • Sympathetic nerve blocks – Using fluoroscopy (x-ray guidance), the doctor can insert a needle near the affected nerve root and inject a long-acting anesthetic agent onto the nerve. In a recent study, bupivacaine and clonidine were used for PHN, and patients remained free of pain for up to eight months.

 

  • Epidural steroid injection (ESI) – This involves injecting a long-acting corticosteroid, with or without an anesthetic, into the epidural space (outside the spinal cord). A recent research report proved ESI effective for alleviating PHN pain.

 

  • Acupuncture – The pain specialist may recommend this ancient Chinese therapy. The practitioner inserts fine needles into acupoints, which lie along the body and help to stimulate endorphin release.

 

  • Pulsed radiofrequency lesioning (PRF) – To destroy a portion of a nerve root, the doctor can insert a special needle and probe near the nerve root. In a recent clinical study involving patients with PHN, this procedure proved to have an 80% success rate.

 

  • Transcutaneous electrical nerve stimulation (TENS) – This involves an external device worn on the outside of the body that delivers electrical impulses to the spine via electrodes. Researchers believe TENS stimulates the release of endorphins from the brain.

 

  • Spinal cord stimulation (SCS) – When other treatments fail, the doctor surgically implants a small device in the buttocks or lower abdomen. Wires connect to electrodes along the spinal cord to emit mild electrical current that interferes with pain signal transmission.

Resources

Dubinsky, RM et al. (2004). Treatment of postherpetic neuralgia: An evidence-based report. Neurology, 63, 959-965.

Kim, YH et al. (2003). Effect of pulsed radiofrequency for postherpetic neuralgia. Acta Anesthesiology Scand, 52, 1140-1143.

Schmader KE (2002). Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clinical Journal of Pain, 18(6), 350-354.