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Postherpetic Neuralgia

Chronic neuropathic pain after shingles

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Postherpetic Neuralgia?

Postherpetic neuralgia is the most common chronic complication of shingles, defined as pain persisting beyond three months after the acute rash resolves.

It results from inflammation and damage to dorsal root ganglia and peripheral sensory nerves, causing peripheral and central sensitization.

Diagnosis is clinical, based on history of zoster in the affected dermatome and characteristic burning, lancinating, or allodynic pain.

Pain may persist for months to years and significantly impairs sleep, mood, and quality of life, particularly in older adults.

Symptoms

Burning, throbbing, or stabbing pain in a dermatomal distribution
Allodynia (pain from light touch, clothing, or breeze)
Hyperalgesia (exaggerated response to painful stimuli)
Numbness or itching alternating with pain
Sleep disturbance and depression secondary to chronic pain
Persistent dermatomal pain three or more months after shingles rash

Risk Factors

Older age (significantly increased risk after 60)
Severe acute zoster pain or rash extent
Ophthalmic zoster (trigeminal involvement)
Female sex slightly increased risk
Immunocompromise (HIV, chemotherapy, biologics)
Delay in initiating antiviral therapy for acute zoster

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent dermatomal pain after resolution of zoster rash
  • Severe pain interfering with sleep or daily function
  • New onset depression or anxiety related to chronic pain
  • Failure of over-the-counter analgesics to provide relief
  • Ophthalmic zoster with eye pain or vision changes
  • Discussion of zoster vaccination for prevention

Treatment Methods

01
Gabapentin or pregabalin titrated to effect, first-line agents
02
Tricyclic antidepressants (amitriptyline, nortriptyline) at low doses
03
Topical lidocaine 5% patch and capsaicin 8% patch (Qutenza)
04
Tramadol or short-term opioids in refractory cases
05
Interventional therapy: nerve blocks, sympathetic blockade, spinal cord stimulation
06
Recombinant zoster vaccine (Shingrix) for prevention in adults over 50

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Let us help you

You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.