A Painful Reminder of Shingles?

Do you have any advice for dealing with postherpetic neuralgia?

– January 14, 2005

Postherpetic neuralgia is a complication of shingles that affects the nerve fibers and skin and can be extremely painful. The symptoms are usually confined to the area where the shingles occurred and may include a sharp, burning or deep, aching pain, extreme sensitivity to touch and temperature change, or itching and numbness. These problems can go on for months, in some cases years, and are most likely to occur among older people. In fact, the older you are when you develop shingles, the more likely you are to develop postherpetic neuralgia. This complication rarely occurs before the age of 50 but does develop in at least 50 percent of shingles patients over 60 and in almost 75 percent of those 70 or older.

Conventional medicine treats postherpetic neuralgia with skin patches that release the pain killer lidocaine and relieve pain for four to 12 hours. Antidepressants, in doses smaller than those used to treat depression, especially tricyclics like amitryptaline (Elavil), seem to make the pain easier to tolerate. Other allopathic options are anticonvulsant drugs such as neurontin, prescription pain medications, and TENS units (transcutaneous electrical nerve stimulation), which involves placing electrodes in the painful area to deliver tiny electrical impulses to nearby nerve pathways.

I suggest trying acupuncture or hypnosis, both of which can help relieve the pain of postherpetic neuralgia. You can also use topical capsaicin, a cream made from hot chili peppers. This medication depletes nerve cells of “substance P,” a natural chemical that is involved in sending pain signals to the brain. You rub the cream on the affected area of skin three times a day. Capsaicin cream is sold over-the-counter as Zostrix or Capzasin-P.

Andrew Weil, M.D.

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