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Home > Post-Herpetic Neuropathy – Part II

Post-Herpetic Neuropathy – Part II

Jenny L.F. Andrus, MD

Jenny L. F. Andrus, MD

In Part I of this three-part series of articles, we defined what post herpetic neuropathy was, how it was caused and how if differs from post-herpetic neuralgia, even though the two terms are sometimes used interchangeably.  In this article we’ll discuss who is at risk for this condition and how I diagnosis it in the office. 

Risk Factors for Post Herpetic Neuropathy (PHN)

PHN happens in about 10-20% of the people who experience shingles and researchers are not sure why some people develop PHN, and some don’t, although the older you are when you have shingles increases your risk for PHN.  White people tend to get PHN twice as often as other races and those who are immuno-compromised will also see higher rates of PHN.

How Post Herpetic Neuropathy is Diagnosed

When patients come to me for treatment of pain, they must be referred by another physician. Usually, patients who have had shingles will have been treated by their primary care physician and will have been worked up for a possible PHN diagnosis before being sent my way.

I will review past medical notes, any diagnostic testing and imaging, and do a thorough medical examination, which will include many questions about the patient, their lifestyle, work, environment, pain, home treatments, etc.  I act like a detective, working with the evidence I have and putting the pieces together to formulate a diagnosis.  If the patient had shingles and presents with nerve pain distribution where shingles lesions were active, then most likely PHN is the culprit.

A patient may also present with scarring on areas of the skin where they had shingles lesions.  They may complain of altered sensations in these areas, maybe being more highly sensitive to the touch (allodynia) or simply different than the surrounding skin.  All of these can point me to the diagnosis of PHN.

In the last part of this series, I’ll discuss the latest treatments for post-herpetic neuropathy and what new treatments may be on the horizon.




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