Nerve Pain: Postherpatic Neuralgia

by Christina Lasich, MD Health Professional

Anyone had chickenpox? If so, then you are at risk for postherpatic neuralgia, a common cause of chronic nerve pain. Follow this timeline. First as a child, you develop chickenpox caused by the Varicella Zoster virus. Then this sinister virus goes dormant in the nervous system. For years, it waits for an opportune time, when the immune system is low, to burst back on to the scene as shingles (a.k.a. herpes zoster). For that reason, this reactivation is most prevalent in conditions that compromise the immunity: elderly, HIV, and some types of cancer. For healthy individuals, the immune system does a good job keeping the Varicella virus in hibernation. Usually the rash and pain of shingles resolves within 3 months, but sometime the nervous system damage leads to chronic nerve pain-postherpatic neuralgia.

The diagnosis of shingles can get a bit tricky because the hallmark rash may or may not be present. Thus, this condition can be misdiagnosed as migraines, heart attack, or herniated disc, depending on the location of the pain. The pain is typically on one side of the body or face and follows the distribution of a specific nerve. The symptoms are typical for nerve pain like burning, tingling, and altered sensitivity. Once diagnosed the key for treating shingles is prompted treatment with an antiviral medication. Valacyclovir has proven to be the best choice. Recently, a vaccine was approved (Zostavax) and is recommended for anyone over the age of 60. Prevention can be worth a pound of cure. This vaccine is meant to boost the immune system that keeps sinister Varicella in check. But even the best intentions can be wrecked by the persistence of pain.

Postherpatic neuralgia is technically pain that persists at least 120 days after the rash outbreak of shingles. Treatment of postherpatic neuralgia is similar to other types of nerve pain. Some medications seem to be better suited for postherpatic neuralgia than others because of their effect on sodium channels. Lyrica and Neurontin are specifically approved for the treatment of postherpatic neuralgia. Lidocaine patches are also particularly effective for this type of nerve pain, again because of some sodium channel blockade. Tricylic antidepressants, opioids, and tramadol (a weak opioid) also can all be useful weapons against nerve pain. Alternatives to medications do exist and can be great options. These adjunctive therapies include: TENS, acupuncture, nerve blocks, and spinal stimulation devices. Without proper treatment, postherpatic neuralgia can have a very significant impact of quality of life as do most chronic painful conditions.

Those who have had chickenpox should be aware of this condition and be on the lookout for the first signs of shingles. Early treatment can prevent years of pain. For more information please visit

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.