Post-herpetic neuralgia: The avoidable suffering | BRIGITTE.de

Action Day against Pain 2024
Treacherous nerve pain that doesn’t have to be there

After shingles, there is a risk of developing a very painful and long-lasting secondary disease: post-herpetic neuralgia. Here you can find out everything about the causes, symptoms, treatment options and how to prevent it from occurring.

Anyone who has ever had a slipped disc or an infected tooth knows how unbearably painful it is. Such pain cannot be ignored or breathed away. This is also the case with post-herpetic neuralgia (PHN).

What is post-herpetic neuralgia?

Post-herpetic neuralgia is the most common complication of Shingles (Zoster or herpes zoster). It is triggered by the reactivation of the chickenpox pathogen, the varicella zoster virus. After the infection has been overcome, these viruses remain in the body for life and can be awakened from deep sleep many years later. This happens, for example, through another infection or when the immune system is generally weakened. The spread of the viruses then leads to inflammation of the nerve pathways.

Acute shingles initially manifests itself with flu-like symptoms. Only after a few days does the typical Rash with red blisters, usually striped or band-shaped on one side of the body. The skin area is extremely sensitive to pain, the pain is usually described as stabbing or burningIf treated promptly, shingles heals after about two to four weeks.

In some cases, however, the pain persists even after the typical shingles rash has subsided. Post-herpetic neuralgia (PHN) occurs when nerve pain lasts longer than three months. However, it can last for years, or in the worst case, even for life.Approximately ten to 30 percent of those affected by shingles develop this complication. The risk is slightly higher for women than for men. “In the European Union, estimates suggest that there are around two million cases of the disease per year, of which at least ten percent have to be admitted to hospital due to complications,” explains pain expert Prof. Dr. Sabine Sator from the Medical University of Vienna in a Technical article.

Why is the secondary disease so painful?

In principle, pain is a Alarm signalIn the case of heat, pressure, injury or inflammation, the stimuli to the pain sensory cells (nociceptors) are transmitted by the nerves via the spinal cord to the pain center in the brain, where they are processed. The body then reflexively tries to end or avoid the stimulus that causes pain: for example, we immediately let go of a coffee mug that is too hot, or we do not put our foot down fully with the injured foot.

In the case of neuropathic pain – which is what post-herpetic neuralgia is – things are different. Here the pain conduction or processing system is damaged, i.e. the nerves themselves (or the spinal cord or brain). The pain is usually described as deep, pulling and burning, like knife stabs, and a tingling sensation can also occur. The pronounced sensitivity to touchThe special thing about this type of pain is that those affected continue to feel the pain long after the original trigger has been eliminated and that the pain can flare up again even after a symptom-free phase.

Examples of neuropathic pain include disc prolapsealso Phantom pain This form of pain includes pain after the amputation of limbs – as well as postherpetic neuralgia or PHN.

How is post-herpetic neuralgia treated?

The pain burden is severe and severely limits the quality of life of those affected. As a result, anxiety disorders and depression often develop. Accordingly, heavy medications must be used in therapy, such as Anticonvulsants (medicines for treating epilepsy) or tricyclic antidepressantsAccording to the guidelines, opioids and lidocaine pain patches for local anesthesia are also available as second-choice options.

The aim of PZN treatment is to reduce pain to a tolerable level and learn to live with the pain. Complete freedom from pain is usually not to be expected. Modern pain therapy today relies on a multimodal treatment concept in which several specialist disciplines are involved: in addition to general medicine, also anesthesiology, dermatology, ophthalmology, ENT, psychiatry and neurology.

Who is particularly at risk?

Every person who in childhood chickenpox – that’s about 95 percent of the population in Germany – carries the varicella zoster virus in their bodies for life. About one in three of this group then develops shingles later in life. If it is not recognized correctly and treated with antiviral drugs within 72 hours, the risk of a serious course of the disease and PHN with severe nerve pain as a long-term consequence increases.

Because the immune system naturally becomes less effective with age, the risk of developing shingles increases steadily from midlife onwardsFor people with pre-existing conditions such as diabetes, rheumatism or asthma, the risk is even 30 percent higher.

How can I protect myself from this?

The sooner shingles is diagnosed and antiviral treatment is started, the better the chances of not developing long-term effects. It is therefore important to see your family doctor immediately if you suspect you have it.

But the main goal is to avoid getting shingles in the first place! Fortunately, there is a Vaccination as a preventive measureThe Standing Committee on Vaccination (STIKO) recommends it to all persons from 60 years. The recommendation means that this group of people is entitled to the vaccination and the costs are covered by the health insurance companies. This also applies to people over 50 years of age if they have an underlying disease such as diabetes, asthma or cancer or if their immune system is impaired by immunosuppressive therapy. This is the case, for example, with rheumatism or chronic inflammatory bowel disease. You can find out more about vaccination against the nerve disease on www.impfen.de/guertelrose or at Robert Koch Institute (RKI)

As a study The herpes zoster vaccine, which is administered in two doses 2–6 months apart, protects at least four years from infection. Other research results show that even after seven years, the effectiveness hardly decreases.

Sources:

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