Post-herpetic Neuralgia

Post-herpetic Neuralgia
Body Parts: Head Neck Back
Medical Subjects: Skin

What Is Postherpetic Neuralgia

What disease is neuralgia after zoster?

Post-herpetic Neuralgia, PHN), mainly refers to the pain still existing four weeks or above after clinical healing of herpes zoster rash area, which is the most common complication of herpes zoster.

PHN has severe pain, such as cauterization, electric shock, knife cut, acupuncture or laceration, and is often accompanied by emotional, sleep and quality of life damage. At present, it is still one of the clinically refractory pain in China and abroad.

Treatment methods include drug therapy, intrathecal injection, surgical therapy, etc. It is recommended that the elderly receive herpes zoster vaccine to reduce the risk of herpes zoster and post-herpetic neuralgia.

Is postherpetic neuralgia common?

According to the 2016 Chinese Experts Consensus on the Diagnosis and Treatment of Post-Herpetic Neuralgia, the incidence of PHN in patients over 60 years old with herpes zoster is 65%, and that in patients over 70 years old with herpes zoster is 75%. Young patients with herpes zoster have a low risk of PHN.


What Is The Cause Of Post-herpetic Neuralgia

What is the cause of post-herpetic neuralgia?

Shingles are caused by reactivation of the varicella zoster virus, which when weakened spreads along the peripheral nerves causing acute neuritis that further leads to structural damage. In addition, the nerve is sensitive so that pain can occur spontaneously.

What person is neuralgia after zoster common in?

  • It is common in the elderly and its incidence increases with age. It is extremely rare in teenagers. The incidence of patients under the age of 60 is less than 2%, and that of people over the age of 70 is as high as 18.5%.

  • Patients with rash and severe pain in the acute phase of herpes zoster are prone to post-herpetic neuralgia.

Can postherpetic neuralgia infect?

Herpes zoster is contagious, while post-herpetic neuralgia is not.

However, herpes zoster is not directly contagious and people who come into contact with herpes zoster's rash do not develop herpes zoster directly. However, if you have never had chickenpox or been vaccinated with chickenpox, you may catch the varicella-zoster virus after coming into contact with the rash of a patient with herpes zoster and develop chickenpox, and herpes zoster may occur later.


What Symptom Does Postherpetic Neuralgia Have

What are the specific manifestations of postherpetic neuralgia?

What are the specific manifestations of post-herpetic neuralgia? The main manifestations are the obvious pain in the affected areas. The pain often has different properties such as burning pain, radioactive pain and traction pain. In most people, the induced pain occurs. In the mild stimulation, such as clothing friction and light touch, the pain can be induced. ?

What serious consequence can postherpetic neuralgia cause?

The pain seriously affects the patients' life, learning, socialization, diet and sleep, making the quality of life significantly decreased, and further leading to anxiety, depression, mania and other aspects of psychological and social problems.


How To Check For Post-Herpetic Neuralgia

How is postherpetic neuralgia (PHN) diagnosed?

A diagnosis can be made by an experienced dermatologist by asking questions about his medical history. The diagnosis of PHN can be made when the herpes zoster pain persists for more than a certain period of time, but there is currently no consensus on this duration, and the diagnosis of PHN can only be made after more than one month, two months, three months or even six months.

What does zoster hind neuralgia (PHN) need to do check?

PHN is usually diagnosed by asking the medical history, and no special examination is required. However, if pain caused by other reasons is suspected, relevant examinations should be conducted to eliminate the pain.

  • ECG: ECG is required when pain is suspected to be caused by heart disease;
  • Myocardial enzyme spectrum: the same as above. When pain caused by heart disease is suspected, blood shall be drawn for myocardial enzyme spectrum examination;
  • CT or ultrasound of thorax and abdomen: Relevant examinations are needed when it is suspected that the pain is caused by chest organs such as lung, and abdominal organs such as intestine, liver and gallbladder.
  • CT or MRI of the head: This examination is needed when brain or vascular factors are suspected to be responsible for the cephalic and facial pain.

What diseases are PHN easily confused with? What's the difference?

Many diseases can also cause pain, and PHN can also be accompanied by pain caused by other diseases. Therefore, the differential diagnosis is particularly important.

  • Angina pectoris/myocardial infarction: differential diagnosis from herpes zoster and PHN in the chest and back is required. Angina pectoris/myocardial infarction are mostly manifested as pain in the chest area or the shoulder and back of the left upper limb, which is squeezing-like and may cause a near-death feeling.
  • Appendicitis: A differential diagnosis from herpes zoster and PHN disease of the right lower back is required. Appendicitis is mostly manifested as tenderness and rebound pain at the right Markov's point, which is often transferred from umbilical pain.

How To Prevent Post-herpetic Neuralgia

How to prevent post-herpetic neuralgia

Vaccination against herpes zoster reduces the risk of developing herpes zoster and post-herpetic neuralgia. No determination of past history of chickenpox or herpes zoster is required prior to inoculation, and no antibody testing is required.


How To Treat Postherpetic Neuralgia

What branch should see after zoster neuralgia?

Dermatology, neurology, pain department.

Does postherpetic neuralgia (PHN) need treatment?

PHN causes great pain to patients and does not relieve itself, so active treatment is needed. Furthermore, long-term treatment is often required because PHN may last for a long time.

How should postherpetic neuralgia (PHN) be treated concretely?

The purpose of PHN treatment is to effectively control severe pain as early as possible, alleviate the accompanying sleep and emotional disorders, and improve the quality of life. The principle of treatment is standardization and persistence. Treatment methods include drug therapy, intrathecal injection, surgical therapy, etc.

  • Oral medications:
  • First-line medications included calcium channel modulators (pregabalin and gabapentin), tricyclic antidepressants (amitriptyline, noramitriptyline), and a 5% lidocaine patch;
  • Second-line drugs include opioids (oxycodone, morphine, methadone), tramadol, and capsaicin patches;
  • For combination therapy, it is recommended that the 5% lidocaine local patch be used in combination with the pregabalin system, or a combination between system drugs, such as the combination of gabapentin/tricyclic antidepressants and morphine/gabapentin.
  • Intrathecal injection: intrathecal glucocorticoid injection is another option for patients with intractable pain who have failed to respond to the above measures. However, intrathecal glucocorticoid injection was not effective for PHN involving the trigeminal nerve.
  • Surgical treatment: Surgical interventions including electrical stimulation of the thalamus, anterolateral spinal cord transection and posterior root electrocoagulation carry a significant risk of permanent neurological dysfunction. Studies fail to demonstrate a consistent benefit of surgery in patients with PHN.

What are the possible risks and complications of treatment options for post-herpetic neuralgia?

  • Oral drugs: adverse reactions possibly caused by drug treatment include dizziness, drowsiness, dry mouth, nausea and vomiting, abnormal thinking, and vague consciousness, while opioid drugs are at the risk of dependence and addiction.
  • Intrathecal injection: intrathecal injection of glucocorticoids significantly improved the pain. Its adverse reaction rate is relatively low, and the possible ones include aseptic meningitis, radiculitis, and headache.
  • Surgical treatments, such as electrical stimulation of the thalamus and percutaneous electrical nerve stimulation, can also improve the pain to a certain extent. But it could lead to permanent neurological dysfunction.

Does postherpetic neuralgia need regular reexamination? Why?

Regular follow-up visit is recommended, and the drug dose and treatment method are adjusted according to the situation.

Can post-herpetic neuralgia (PHN) be cured after treatment?

It can heal, but PHN can persist for months or years and may even require life-long treatment.


What Should The Patient Of Neuralgia Of Zoster Hind Notice In Life

What should the person after zoster neuralgia notice on food?

Avoid spicy food stimulation on the diet, avoid tobacco, other do not need special attention, daily balanced nutrition.

What should the person after zoster neuralgia notice in life?

  • Work and rest regularly and stay up less;
  • Relax, avoid stress, avoid mental stress;
  • Once suffering from herpes zoster timely treatment, and actively carry out regular diagnosis and treatment, to avoid the use of folk prescription earthwork.

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