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Home > Post-Herpetic Neuropathy – Part III

Post-Herpetic Neuropathy – Part III

Jenny L.F. Andrus, MD

Jenny L. F. Andrus, MD

In part III of this series, we’ll discuss the latest conservative treatments for Post Herpetic Neuropathy.

Have you ever heard the adage “an ounce of prevention is worth a pound of cure”?  When it comes to shingles, I’d change that to “a ton of cure”!  Although there is no foolproof method of preventing shingles, especially if you’ve had chickenpox, I’d recommend doing everything you can to prevent getting them as an adult.

Physicians strongly recommend that patients, regardless of having had chickenpox or not, get vaccinated against shingles.  Shingrix® which is given in two injections, provides about 85% protection from the development of shingles for the first four years after vaccination. At the time of this writing, Shingrix® is our most effective vaccine and until another more potent and efficacious anti-viral is developed, it is what I recommend to my patients.

If you do happen to come down with shingles or even suspect you may have shingles, run, don’t walk, to your primary care physician for anti-viral drug therapy as soon as possible.  Doing so may greatly lessen the severity of your shingles as well as the risk for post-herpetic neuropathy.

What are the treatments for Post Herpetic Neuropathy? 

As a Pain Management Physician, it is important for me to get to the root cause of the pain, which in this case is the actual damage to the nerves themselves by the shingles virus or varicella zoster.  Can the actual nerve damage be repaired, or can we only treat the painful symptoms which is known as post herpetic neuralgia?

Medications to treat nerve pain will do nothing to help repair the damaged nerves but will provide much needed relief to the PHN sufferer.  I typically will work with my patients to treat their nerve pain with a combination of nerve-calming drugs, such as gabapentin and pregabalin, a tricyclic anti-depressant proven to treat nerve pain, nortriptyline or amitriptyline and topical pain creams and patches. Often, using OTC pain relievers like naproxen sodium or acetaminophen can provide ample pain relief.  Occasionally, I may need to add a muscle relaxant or stronger pain medication for breakthrough pain.

Patients who suffer with severe post-herpetic neuropathy and neuralgia who are debilitated by chronic pain may benefit from more intensive therapies, such as electronic cell signaling therapy (ECST), peripheral nerve stimulation (PNS) or Electronic Spinal Cord Stimulation (ESCS).  I’ll discuss these in our final segment of this four-part series.












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