Post-Herpetic Neuralgia (PHN)

Understanding Persistent Pain After Shingles

Neurology

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Last updated: Mar 24, 2025

What is Post-Herpetic Neuralgia?

Post-herpetic neuralgia (PHN) is a painful condition that occurs as a complication of shingles (herpes zoster). It's characterized by persistent nerve pain that continues after the shingles rash has healed.

Key Facts

  • PHN affects 10-20% of people who get shingles
  • Risk increases significantly with age
  • Pain can persist for months or years
  • Early treatment of shingles may reduce PHN risk

Symptoms

Primary Symptoms

  • Burning, constant pain
  • Sharp, shooting sensations
  • Extreme sensitivity to touch
  • Itching and numbness

Affected Areas

  • Usually occurs where the shingles rash was located
  • Most commonly affects the torso
  • Can occur on face, arms, or legs

Risk Factors

  • Age over 50
  • Severe initial shingles pain
  • Extensive rash during shingles
  • Compromised immune system

Treatment Options

Medications

  1. Anticonvulsants

    • Gabapentin
    • Pregabalin
  2. Antidepressants

    • Tricyclic antidepressants
    • SNRIs
  3. Topical Treatments

    • Lidocaine patches
    • Capsaicin cream

Other Therapies

  • Physical therapy
  • TENS (Transcutaneous electrical nerve stimulation)
  • Psychological support

Prevention

  • Get the shingles vaccine (recommended for adults 50+)
  • Seek prompt treatment if shingles develops
  • Follow prescribed antiviral medication regimen

When to See a Doctor

  • If pain persists after shingles rash heals
  • When pain interferes with daily activities
  • If current treatments aren't providing relief

Living with PHN

  • Keep affected area protected
  • Wear loose-fitting clothes
  • Use stress management techniques
  • Maintain regular sleep patterns
  • Stay physically active as tolerated

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