Herpes zoster is the medical term for shingles. It is a viral infection that typically causes acute pain in most patients who are affected with it. One of the main problems with herpes zoster is that even when the virus settles down a bit it can still leave substantial residual pain in a lot of patients. This is called postherpetic neuralgia.
Herpes zoster results after a chickenpox infection which is the same virus. Even when chickenpox resolves, the virus still stays in the body in a latent fashion. It can become reactivated in adults for any number of reasons.
About 1 million people annually are affected by herpes zoster, with a lifetime incidence of 20 to 30% of the population. It is especially common in those who have immunosuppression such as those who have organ transplants, HIV and certain cancers.
The presentation of pain with herpes zoster is variable. Usually there is some pain over the skin which comes on before a rash appears on one side of the body. 50 to 70% of zoster cases take place in the thoracic region. 10 to 20% occur in the cervical and lumbar region and about 8% occur in the sacral area.
At times, an individual may have the severe pain without a rash appearing. There can be additional issues besides just a rash and severe pain. Individuals can sustain a stroke, complications with the eyes, motor neuropathy, transverse myelitis and glaucoma.
Treatment of herpes zoster
Antiviral medications should be given as first-line treatments to those with herpes zoster who are age 50 or older. Even in those younger if severe rash or pain is present, then a medication such as Acyclovir and others in the same family can help to heal the rash, decrease the pain and prevent postherpetic neuralgia.
About 20% of those over the age of 50 with zoster pain end up with continued pain for six months after their rash heals despite taking antiviral medications. Opioid medications are often added to the mix, and some doctors will use Neurontin as well because in some smaller studies that showed benefit.
Multiple studies have looked at epidural steroid injections for the treatment of zoster pain. One study showed acute pain relief during the zoster phase but did not reduce the risk of developing postherpetic neuralgia. Other studies have looked at multiple epidural injections or continuous epidural infusions which have shown a reduction of the incidence of postherpetic neuralgia.
First-line treatment should definitely be antivirals plus opiates. It is unclear if the addition of an oral corticosteroid is beneficial. If these are not quite managing the pain, then the AZ pain management doctor can perform epidural injections.
The actual definition of Post Herpetic Neuralgia is defined as pain that lasts for at least six months after the onset of the rash. Unfortunately, the condition can last for years and lead to a significant reduction in a person’s quality-of-life. The pain can wax and wane is typically described as being sharp and stabbing along with burning.
When it comes to treatment for postherpetic neuralgia, first-line therapy should consist of tricyclic antidepressants and maybe Neurontin, Lidocaine patches, opiates, Tramadol and maybe a capsaicin patch.
Unfortunately, a significant number of patients will not respond well to medication management for postherpetic neuralgia. Interventional pain management for the problem may consist of sympathetic nerve blocks. These are often very effective for temporary relief but not so great for longer lasting relief. Studies looking at spinal cord stimulation showed long-term benefits in over 80% of patients with postherpetic neuralgia. The study included 28 patients and was very promising.
Arizona Pain Specialists has been providing successful relief for chronic pain conditions for years, and recently received its 5th Consecutive Patient’s Choice Award. The Pain Management doctors work closely with Phoenix chiropractors at the clinics to provide comprehensive relief options.
If you or a loved one is suffering from chronic pain due to post herpetic neuralgia or a condition such as failed surgery, help is available at Arizona Pain. Call (602) 507-6550 today for treatment with the best pain management doctors in Arizona.