Understanding and Managing Post-Herpetic Neuralgia

At Horizon Spine & Pain of Utah, we specialize in providing relief for patients living with post-herpetic neuralgia (PHN) — a long-lasting nerve pain condition that can follow a shingles outbreak. Our comprehensive care approach addresses both immediate symptoms and long-term management strategies to restore your comfort and quality of life.

Post-herpetic neuralgia is nerve pain that persists 90 days or longer after a shingles rash has healed. It is caused by nerve damage from the varicella-zoster virus, the same virus responsible for chickenpox and shingles. PHN can significantly impact daily activities due to its intensity and chronic nature.

PHN develops when the shingles virus damages peripheral nerves, causing them to misfire pain signals even after the skin has healed. The greater the severity of the shingles outbreak, the higher the likelihood of nerve injury and lasting pain.

Several factors can increase your risk of developing post-herpetic neuralgia:

• Age over 60
• Severe shingles outbreaks
• Delayed antiviral treatment
• Weakened immune system (due to conditions like diabetes, cancer, or autoimmune diseases)
• Location of rash (face and chest rashes carry a higher risk)

Early treatment of shingles significantly reduces the risk of PHN.

Symptoms of PHN often include:

• Burning, stabbing, or sharp pain in the area of the healed rash
• Extreme sensitivity to touch (even clothing can cause discomfort)
• Numbness or tingling
• Itching or electric-shock sensations
• Muscle weakness or fatigue near the affected area

Pain can be constant or intermittent and typically worsens with stress, cold weather, or light touch.

At Horizon Spine & Pain of Utah, diagnosing PHN begins with:

• Comprehensive medical history review, focusing on recent shingles infections
• Detailed neurological examination
• Pain mapping to assess the distribution and severity of nerve symptoms
• Diagnostic nerve testing (in select cases)

Diagnosis is largely clinical, based on your symptoms and history of shingles.

Effective post-herpetic neuralgia treatment often requires a multimodal approach. Our non-surgical therapies include:

• Anticonvulsants (gabapentin, pregabalin) to calm nerve signals
• Tricyclic antidepressants (amitriptyline, nortriptyline) to reduce pain transmission
• Topical lidocaine patches and capsaicin cream for localized pain control
• Physical therapy to improve circulation and reduce hypersensitivity
• Cognitive Behavioral Therapy (CBT) for coping with chronic pain

For severe cases, we offer advanced pain management techniques:

• Nerve blocks: Temporary pain relief by injecting anesthetics around affected nerves
• Epidural steroid injections: Reducing inflammation and easing nerve irritation
• Spinal cord stimulation: A minimally invasive procedure using mild electrical pulses to disrupt pain signals

These therapies can provide significant relief when medications alone aren't enough.

Surgery for PHN is rare and considered only when all conservative treatments fail. Options might include:

• Peripheral nerve stimulation
• Destructive neurosurgical procedures (used only in extreme, disabling cases)

We focus on maximizing non-surgical success before discussing surgical interventions.

Choosing Horizon Spine & Pain of Utah means you are choosing a team committed to:

• Board-certified specialists in pain management and neurology
• Individualized treatment plans based on your unique needs
• Access to the latest technologies in pain relief and nerve care
• Compassionate, patient-centered care from start to finish
• Education and support resources

We pride ourselves on helping patients regain their strength, independence, and well-being after shingles-related nerve pain.