Postherpetic neuralgia

Diagnosis

To diagnose postherpetic neuralgia, a healthcare professional may first ask if you've had shingles and if your pain has lasted three months or more. Postherpetic neuralgia may be diagnosed by checking for pain in the area where you had shingles. For most people, no other tests are needed.

Treatment

Postherpetic neuralgia treatment is used to ease postherpetic neuralgia pain and to make it go away sooner. Treatment also helps prevent other issues and improve quality of life. Postherpetic neuralgia has no cure, but it often gets better over time. No single treatment relieves postherpetic neuralgia for everyone. It may take a mix of treatments to ease the pain.

Lidocaine

Lidocaine is a treatment you put on the skin for short-term relief of mild postherpetic neuralgia pain. It comes in different forms, including creams, gels and small bandagelike patches. Your healthcare professional may prescribe lidocaine, or you can buy it without a prescription at lower doses.

Capsaicin

Capsaicin is a medicine put on the skin to relieve mild postherpetic neuralgia pain. You can buy it without a prescription for short-term relief.

It also comes in a high-dose skin prescription patch called Qutenza. You can only get Qutenza from your healthcare professional, who applies the patch to your skin. The process may take about two hours, as your healthcare team needs to watch for any side effects after the patch goes on. The patch may help relieve pain for up to three months. If it works, you can get a new patch every three months.

Anticonvulsants

Some medicines for seizures also may be used to ease moderate to severe pain from postherpetic neuralgia. Anticonvulsants calm injured nerves and may help with pain even if you do not have seizures. These medicines include:

• Gabapentin.
• Pregabalin.

Side effects may include:

• Feeling sleepy.
• Weight gain.
• Feeling dizzy.
• Not feeling steady when walking.

Antidepressants

Some depression medicines also may be used to ease moderate to severe pain from postherpetic neuralgia. These medicines affect key brain chemicals that play a role in how the body feels pain. In smaller doses, they may help with pain even when you do not have depression. These medicines include:

• Nortriptyline.
• Amitriptyline.
• Duloxetine.
• Venlafaxine.

Side effects may include:

• Weight gain.
• Feeling sleepy.
• Dry mouth.
• Feeling groggy or faint.

Opioid pain relief

Opioids are very strong medicines that a healthcare professional may prescribe for postherpetic neuralgia pain. These may include:

• Tramadol
• Oxycodone
• Morphine

Opioids can cause side effects such as:

• Constipation.
• Nausea.
• Feeling sleepy.
• It may be hard to breathe.
• Itching.
• Hormone issues.

An opioid may be prescribed for postherpetic neuralgia only if safer treatments haven't worked. Before you start taking an opioid, your healthcare professional may:

• Explain the medicine's benefits and risks.
• Set up treatment goals for pain relief.
• Make a plan to help you safely stop opioids.

Driving while taking opioids is dangerous. And it's not safe to take an opioid along with alcohol or other medicines. Talk with your healthcare professional if you are taking other medicines. Take the lowest possible dose of an opioid. And get checkups as often as your healthcare professional suggests.

Keep all prescription medicines and medicines you buy without a prescription out of the reach of children.

Injections

Postherpetic neuralgia may be treated with nerve blocks or shots, also called injections, into the spine and other painful areas. These treatments are used when medicines you take by mouth do not do enough to relieve pain. Shots may include:

• Cortisol hormone.
• OnabotulinumtoxinA.
• Epidural nerve block.

Other treatments

Some treatments send electrical pulses to your nerves to help control postherpetic neuralgia pain levels. These are called pulsed radio frequency and spinal cord stimulators. Acupuncture also may offer some pain relief, but additional research is needed.

Preparing for your appointment

You might start by seeing your family healthcare professional. You may be referred to a nerve specialist called a neurologist. Or your healthcare professional may suggest you see a doctor who specializes in treating long-term pain.

Here's information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. For instance, you may need to stop eating for a certain amount of time before you take a medical test. Make a list of:

• Your symptoms, including any that don't seem related to the reason for your checkup. Be sure to note when symptoms began.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins and other supplements you take, including doses.
• Questions to ask your healthcare professional.

Take a family member or friend along if you can. This person can help you remember the information you're given.

For postherpetic neuralgia, questions to ask your care team include:

• How long might my symptoms last?
• What treatment do you suggest? And are there other choices?
• I have other health problems. How can I best manage them together?
• Is there anything I shouldn't do while I recover?
• Should I see a specialist?
• Are there brochures or other printed materials I can have? What websites do you recommend?

Feel free to ask any other questions you may have.

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

• Do your symptoms happen some or all the time?
• How bad are your symptoms?
• Have you had chickenpox? When?
• Have you had a shingles vaccine?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to make your symptoms worse?