Neuralgia, postherpetic

Post-herpetic neuralgia is a persistent nerve pain that occurs at the site of a previous attack of a condition called shingles.

It's estimated that up to one in every five people with shingles will go on to develop post-herpetic neuralgia, and older people are particularly at risk.

The pain can improve after a few months and medication can help control it in the meantime, although some cases are more persistent and can even be permanent.

Why does it happen?

In post-herpetic neuralgia, the varicella zoster virus (the virus that causes chickenpox and shingles) damages nerves under the skin of the affected area.

It is not clear why some people with shingles develop post-herpetic neuralgia, but increasing age, pain in the early (prodromal) stage of a shingles attack and severe pain throughout an episode of shingles are all associated with an increased risk of the condition.

Signs and symptoms

The main symptom of post-herpetic neuralgia is continuous nerve pain in an area previously affected by shingles. The pain has been described as burning, stabbing, shooting, aching or throbbing.

The affected area may also:

feel intensely itchy
be more sensitive to pain than usual (hyperalgesia)
feel painful as a result of something that would not normally hurt (allodynia), such as a light touch or a cool breeze

Living with post-herpetic neuralgia can be very difficult, as it can interfere with your ability to carry out certain daily activities, such as dressing and bathing, and can lead to further problems such as extreme tiredness (fatigue), sleeping difficulties and depression.

Read about living with long-term pain for information and tips on how to cope.

Seeing your GP

It is important to revisit your GP if you experience persistent pain after having shingles to discuss the medications available to help control it.

Post-herpetic neuralgia is easy to diagnose based on your symptoms and medical history because it only occurs as a complication of shingles, and the pain will be in the area of the body that was affected by the condition.

How post-herpetic neuralgia is treated

Many people with post-herpetic neuralgia make a full recovery within a year of developing the condition. But occasionally the nerves do not heal completely and symptoms last for several years or permanently.

Medication can ease the symptoms of post-herpetic neuralgia, although they may not relieve the pain completely.

As post-herpetic neuralgia generally doesn't respond to standard painkillers such as paracetamol and ibuprofen, alternative medications will need to be prescribed.

These will often be medications originally intended to treat depression (antidepressants) or epilepsy (anticonvulsants), but have since been found to also be effective in relieving nerve pain.

Read more about treating post-herpetic neuralgia.

Can post-herpetic neuralgia be prevented?

There is no definite way to prevent post-herpetic neuralgia. However, antiviral medication will often be given early during an episode of shingles to help reduce the risk of complications such as post-herpetic neuralgia.

Alternatively, you can reduce your risk of post-herpetic neuralgia by having the shingles vaccination to try to prevent an attack of shingles occurring.

This vaccine is routinely offered to older people on the NHS. It is given as a single injection to anyone aged 70. There is also a catch-up programme for those aged 79 and, from September 2014, 78 and 79-year-olds. You will only need to have this vaccine once.

If you wish to have the shingles vaccine and you are not eligible for the NHS vaccination programme, you will usually need to visit a private clinic. Private vaccination is likely to cost £100 to £200.