Postherpetic Neuralgia – Diagnosis and Treatment
Diagnosis
Doctors often rely on a physical check of the skin and may gently press different spots to see where the nerve pain stops or starts. Blood tests or scans are rarely needed.
This process helps spot postherpetic neuralgia, especially after a shingles outbreak. A key part of diagnosis is reviewing the person’s medical history—particularly if they had shingles in the past few weeks or months.
The pain in postherpetic neuralgia usually lingers after the rash from shingles has healed and may feel sharp, burning, or electric-like.
During the exam, the doctor may test how the skin responds to light touch, temperature, or vibration. Areas affected by postherpetic neuralgia often become overly sensitive or numb.
In rare cases, imaging tests like MRI may be used to rule out other causes of nerve pain, such as spinal problems or tumors, especially if the pain pattern is unusual or not linked to a known shingles outbreak.
Treatment
Topical Anesthetic Patches
People may use topical anesthetic patches containing a local numbing agent to cover painful areas of the skin. These patches numb the area and provide temporary pain relief.
Some patches need a prescription, but milder versions are available without one. People can trim the patches to fit around affected spots, helping control discomfort from postherpetic neuralgia. Store the patches safely and keep them away from children.
High-Dose Capsaicin Patch
A healthcare provider can apply a high-strength capsaicin patch to help lessen nerve pain linked to postherpetic neuralgia. The provider first numbs the skin with a local anesthetic, then applies the patch.
The process can take two hours or more, and staff monitor patients for side effects. Pain relief might last for months, and if effective, patients might receive a new patch up to every three months.
Nerve-Calming Seizure Medications
Doctors may prescribe nerve-calming anticonvulsant medications to help with nerve pain. These drugs were originally developed to control seizures but are also used to soothe overactive nerves.
People taking them might feel sleepy, have trouble thinking clearly, or feel unsteady. Some also notice swelling in their feet. Doctors usually adjust doses to balance pain relief with side effects.
Mood-Related Medicines for Nerve Pain
Doctors sometimes use antidepressant medications to help ease nerve pain. These drugs affect brain chemicals that influence both mood and how the body processes pain.
Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used, often in lower doses than when prescribed for depression.
Even if a person is not depressed, these medications may help reduce pain signals and improve comfort.
Possible Side Effects:
- Drowsiness
- Dry mouth
- Dizziness when standing
- Weight gain
Strong Prescription Pain Medicines
Doctors sometimes prescribe opioid pain medications when other treatments do not work.
These drugs are used to manage strong or persistent pain but may also lead to side effects such as drowsiness, dizziness, confusion, and constipation. There is also a risk for dependence and addiction.
Experts recommend using opioids for postherpetic neuralgia only after safer options have failed and under close medical supervision.
Doctors must clearly explain the risks and benefits before prescribing opioids. They should also create a treatment plan, outline goals, and monitor patients closely.
Patients should take the lowest possible opioid dose and avoid combining them with alcohol or other sedating drugs due to added safety concerns.
Injection Therapy with Steroids
Healthcare providers may give steroid injections, such as corticosteroids near the spine to help manage ongoing nerve pain. These injections can sometimes lessen discomfort when other treatments are not enough.
Steroids reduce inflammation around nerves, which may decrease pain signals sent to the brain. Only a healthcare provider should give these injections, and they are usually reserved for select cases where stronger relief is needed.
Everyday Methods and At-Home Solutions
People can take several at-home steps to lower discomfort linked to postherpetic neuralgia, which often develops after a painful infection with the varicella zoster virus.
Applying capsaicin cream, made from hot chili peppers, may help lessen pain. Use it sparingly and avoid broken or sensitive skin.
- Wear gloves when putting on the cream.
- Wash hands well after use.
- Apply only on affected areas.
Cool compresses, gentle baths, and light clothing help relax irritated skin where blisters or inflammation are present.
These steps may bring comfort, especially for those with sensitive skin or weakened immune systems. Some people use acupuncture for pain relief, though results can vary.
Getting Ready for Your Visit
Steps You Can Take Before the Appointment
Taking a few steps ahead of time can help make the visit more effective:
- Write down your symptoms. List all symptoms, even those that may not seem related. Note when they started and how they change over time.
- Record personal details. Bring information about any recent stresses, life changes, and family health history.
- List all medications and supplements. Include the name, dosage, and how often they are taken. This helps avoid problems with drug interactions.
- Prepare questions. Consider asking about the expected duration of symptoms, recommended treatments, possible alternatives, managing other health issues, and any restrictions during recovery. Here’s an example table:
| Topic | Example Question |
|---|---|
| Symptoms duration | How long might these symptoms last? |
| Treatment options | What treatments or alternatives are there? |
| Managing other conditions | How do I deal with my other health problems? |
| Specialist advice | Should I visit a nerve or pain specialist? |
Bringing a trusted family member or friend helps, especially if remembering information is difficult. They can help take notes and ask questions.
If you take part in a clinical trial or use placebo treatments, mention this. Let the doctor know if you have had any side effects or changes in your condition.
Providing all this information helps tailor your care to current guidelines and reduces the risk of medicine interactions.
Questions Your Healthcare Provider May Ask
Doctors might ask several questions to better understand your situation:
- How often do your symptoms appear, and how severe are they?
- Have you had chickenpox or a shingles vaccine? If so, when?
- What makes symptoms better or worse?
- What current and past treatments have you tried?
- Are you taking any specific dosages of medication?
Providing accurate answers helps the provider judge the natural history of your condition and plan the next steps.
The provider may refer you to a pain or nerve specialist or suggest new strategies based on current medical standards.
