Pain after shingles (postherpetic neuralgia) Mamae i muri i te mate koroputa

We do not completely understand why some people get ongoing pain after shingles. We know that shingles causes nerve inflammation and that you can expect pain while you have the shingles rash.

Shingles

It is possible that lasting pain may be related to the scar tissue next to the nerve or in the nearby part of the spinal cord that may cause pain messages to be sent to your brain.

You have a higher risk of getting postherpetic neuralgia if you:

• are older than 50 years — the older you are, the more likely you are to get it
• have shingles on your face or chest area
• have a severe rash and severe pain during your shingles infection
• have other illnesses such as diabetes
• have not had the shingles vaccine — the vaccine reduces the risk of developing pain after shingles
• do not have antiviral treatment within 72 hours of your rash appearing.

The main symptom is pain in the area of your skin where you first had shingles. Commonly, this is in a band on one side of your body. You may experience:

• pain that can be described as burning, sharp and jabbing, or deep and aching
• skin that is very sensitive to the slightest touch, even from clothing
• an itchy feeling or numbness.

Living with postherpetic neuralgia can be very difficult because it can affect your ability to carry out simple daily activities, such as dressing and bathing. It can also lead to further problems, including:

• extreme tiredness
• sleeping difficulties
• depression.

Speak to your healthcare provider if you need support in any of those areas.

Your healthcare provider will ask about your symptoms and history of having shingles, and do a physical examination.

Postherpetic neuralgia is a type of nerve pain or neuropathic pain, so normal pain relief like paracetamol and ibuprofen are not likely to be helpful. Other medicines may not stop the pain completely, but they can reduce it. You may need to try several types of medicine to find what works for you. The following medications have been found to be helpful.

• Capsaicin cream. Rub a pea-sized amount of the cream onto the painful area of your skin 3 to 4 times a day, leaving a gap of at least 4 hours in between. Wash any leftover cream from your hands after applying. You should only apply it to healed skin, not on blisters as it can cause a painful burning feeling. Capsaicin is thought to work by blocking nerves from sending pain messages.
• Antidepressants. Some medicines used to treat depression also work for nerve pain. They include amitriptyline and nortriptyline.
• Gabapentinoids such as gabapentin and pregabalin. These usually ease the pain within a few days. But it may take 2 to 3 weeks to ease, and it can take several weeks before you have the full benefit.

My Medicines

There are some things you can do to help manage the pain.

• Wear comfortable clothing — cotton or silk clothing usually causes less irritation.
• Try covering the painful area with cling film or a plastic wound dressing to protect it.
• Use cold packs — you can wrap ice pack in a towel to apply on the affected area to cool the skin for up to 20 minutes every few hours (do not apply ice directly to your skin).
• Try using a TENS machine — TENS is transcutaneous electrical nerve stimulation. It can help ease pain by passing a weak electrical current to your nerves. Place the pads near the area of pain. You can buy or hire a TENS machine online or from some pharmacies or physiotherapy clinics.

Having the shingles vaccine can reduce the chance that you will get postherpetic neuralgia.

Shingles vaccine