Medicines for Post-herpetic neuralgia

What it is

Post-herpetic neuralgia is persistent nerve pain that can occur after an episode of shingles, continuing in the area where the shingles rash was, after the rash itself has healed. It is the most common complication of shingles, and is caused by damage to the nerves from the shingles infection (shingles is a reactivation of the chickenpox virus, which affects a nerve and the area of skin it supplies). Post-herpetic neuralgia is more common in older people, and the risk increases with age; it is also more likely after more severe shingles. The pain of post-herpetic neuralgia is felt in the area that was affected by the shingles rash (often on one side of the body, such as part of the trunk or the face), and can be described in various ways — such as a burning, stabbing, aching, or throbbing pain; the skin in the area may also be very sensitive, so that even light touch (such as clothing) is painful, and there may be itching or numbness. The pain can range from mild to severe, and can be persistent and distressing, affecting sleep, mood, and daily life, particularly when severe or long-lasting. Post-herpetic neuralgia can last for months, and sometimes longer, though it tends to improve over time in many people. Importantly, it is treatable — a range of treatments can help reduce the pain and its impact, and support is available. Two key points about prevention: the risk of post-herpetic neuralgia (and shingles) is reduced by the shingles vaccine, which is offered to older adults; and treating shingles promptly (with antiviral medicine early in the illness, particularly in those at higher risk) may reduce the risk or severity of post-herpetic neuralgia. The key messages are that post-herpetic neuralgia is nerve pain that can follow shingles and can be distressing but is treatable, and that the shingles vaccine and prompt treatment of shingles help prevent or reduce it.

How it is treated

Post-herpetic neuralgia is treatable, and management focuses on reducing the nerve pain and its impact, with prevention through the shingles vaccine and prompt treatment of shingles. For someone with post-herpetic neuralgia, treatment aims to relieve the pain and improve quality of life, and a range of options is used, often tailored and adjusted to the individual: nerve pain does not usually respond well to ordinary painkillers, so specific treatments for nerve pain are often used — these include certain medicines that act on nerve pain (such as particular medicines originally developed for other conditions but effective for nerve pain, prescribed and adjusted by a doctor); treatments applied to the skin in the affected area (such as certain creams, patches, or preparations) can help some people; and simple pain relief may help mild pain or be used alongside other measures. Because the pain can affect sleep, mood, and daily life, addressing these — and providing support and, where needed, help for the impact on wellbeing — is important, and for severe or persistent pain, referral to a specialist pain service may help, where further treatments and approaches are available. The pain tends to improve over time in many people, though it can be persistent, and treatment is adjusted accordingly. Prevention is an important part of the picture: the shingles vaccine, offered to older adults, reduces the risk of shingles and of post-herpetic neuralgia, and is worth taking up when offered; and treating shingles promptly, particularly starting antiviral medicine early in the illness in those advised to (such as older people or those at higher risk), may reduce the risk or severity of post-herpetic neuralgia — so seeking prompt advice at the start of shingles is worthwhile. It is worth seeing a GP for pain that persists after shingles, so it can be assessed and treated, and for support with its impact. The reassuring messages are that post-herpetic neuralgia, though it can be distressing and persistent, is treatable — with specific nerve-pain treatments and support — and often improves over time, and that the shingles vaccine and prompt treatment of shingles help prevent or reduce it.