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Postherpetic Neuralgia

Postherpetic neuralgia is a nerve damage caused by varicella zoster virus. It is one of the complications of herpes zoster or shingles. Shingles disappear after a few weeks but if the pain persists after, it is considered as a postherpetic neuralgia. The dermatomic area of the skin is damaged in which the nerves send signals into the brain causing severe pain that lasts for years. This pain can greatly affect the individualâ€™s appetite and daily work.

Higher incidence of postherpetic neuralgia occurs in older individuals, primarily over the age of 60, and those who have low immune system. Signs and symptoms include the appearance of scarring from the herpes zoster vesicles, severe and chronic pain, and in most cases, muscle weakness and paralysis. The pain is characterized as burning, sharp, and deep. Due to severe pain, they cannot tolerate even a touch of a light object in their skin. Often, postherpetic neuralgia causes numbness and itchiness.

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Laboratory studies show an abnormality in the cerebrospinal fluid (CSF). Viral culture and antibody determination are other laboratory tests to be done to determine a positive herpes zoster disease. Magnetic resonance imaging (MRI) can as well show lesions in the brain stem and cervical cord.

Most of the treatment basically focuses on alleviating pain and promoting comfort measures to the patients with postherpetic neuralgia.

Anitiviral medications are given during herpes zoster attack while reducing the risk of developing complications like postherpetic neuralgia.
Paracetamol and non-steroidal anti-inflammatory drugs are analgesic medication that can be used but have lesser effect.
Lidocaine skin patches are prescribed to relieve pain usually for 4 to 12 hours by applying the small bandage-like patches topically.
Some anticonvulsants are also administered to minimize pain. They act on the affected nerve system by stabilizing abnormal electrical activity in the nervous system. The commonly prescribed drugs are gabapentin (Neurontin), pregabalin (Lyrica), and phenytoin (Dilantin).
Antidepressant medications are given in low dosages. They work against serotonin and norepinephrine that contribute in both depression and in interpreting pain. They do not get rid of the pain but make it more tolerable. Antidepressant medications are not advised to be taken with opioid medications.
Opioids can give more potent pain relief. They have sedating properties for lessening pain episodes. Examples of these drugs are codeine, morphine, fentanyl. Tramadol, on the other hand, is a therapeutic alternative to opioids in controlling pain, particularly those who are not depressed. It is the drug of choice for postherpetic neuralgia patients with cardiovascular disease. It has opioid-like properties but is not totally addictive, though abuse and dependence have been shown. It is not wise to take tramadol with no prescription. It is safe to buy tramadol and other opioid medications upon the doctor's approval. Following the prescribed number of drugs to be taken is best to avoid dependence and abuse. Search about opioids and tramadol online to learn the benefits and dangers of these drugs.

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