Postherpetic neuralgia is a nerve disease occurs after an attack of herpes zoster infection. Herpes zoster or ‘shingles’ is a viral infection which affects the skin, especially sides of the chest, caused by varicella zoster virus. This is the same virus which causes chicken pox in children.
After an episode of herpes, the virus remains dormant in the nerve tissues of the body. This virus may become active when the immunity of the individual reduces or during convalescence after a major illness, resulting in blisters on the skin, known as shingles. It is accompanied with a rash which disappears without major consequences in about two to four weeks. Around 50% of individuals with shingles go on to develop post herpetic neuralgia (PHN) or after-shingles pain.
The neuralgia begins when the herpetic eruptions begin to heal. The pain appears usually in the affected dermatone or the affected nerve course and results in severe pain in the region which has the same nerve supply. The pain is a drawing, pricking type of intense pain, sometimes accompanied with burning sensation of the skin. The pain lasts from a few weeks to few months, rarely years.
- Severe rash within three days of shingles infection
- A study shows that, 65% of patients were women
- The chances of developing PHN, increases when the shingles occurs in persons over 50 years.
- The incidence of herpes zoster is up to 15 times higher in HIV-infected patients than in uninfected persons, and as many as 25 percent of patients with Hodgkin's lymphoma develop herpes zoster.
- Blacks are one fourth as likely as whites to develop this condition.
- Site of HZ involvement
- Lower risk - Jaw, neck, sacral, and lumbar
- Moderate risk - Thoracic
- Highest risk - Trigeminal (especially ophthalmic division), brachial plexus.
Signs and symptoms:
- A pain that continues for 3 months or more, after the healing of shingles, is defined as PHN.
- PHN pain may be burning, aching, itching and sharp and the pain can be constant or it can come and go
- The skin which was affected with blisters, may show scarring
- The involved deramatome may show altered sensations, either hypersensitivity or reduced sensitivity.
- In rare cases,where if the nerves involved also control muscle movement, the patient might also experience muscle weakness, tremor or paralysis
The conventional treatment is directed at pain control while waiting for the condition to resolve. Pain therapy may include multiple interventions, such as topical medications, over-the-counter analgesics, tricyclic antidepressants, anticonvulsants and a number of non medical modalities. Occasionally, narcotics may be required.
Mezereum – For Postherpetic Neuralgia with Intense Burning
Mezereum is rated among the best medicines for postherpetic neuralgia. It is the best-suited prescription when postherpetic neuralgic pains are violent and attended with marked burning. Mezereum is the most helpful among medicines for postherpetic neuralgia in postherpetic pains located in the face. The pain in the face may get worse while eating. Warmth brings relief. Mezereum is also helpful during active herpes zoster where eruptions are present. The key symptoms to look out for before prescribing Mezereum during herpes zoster infection are violently itching vesicles with shining red areola and intense burning.
2. Ranunculus Bulbosus – For Pains coming in Paroxysms
Another of the prominently indicated medicines for postherpetic neuralgia is Ranunculus Bulbosus. It is indicated for sharp, shooting, postherpetic neuralgic pains that come in paroxysms. It is also one of the top listed medicines for intercostal neuralgia following herpetic infection. Ranunculus Bulbosus is also indicated for herpes zoster when the vesicles eruptions are bluish in colour. The eruptions are attended with itching and burning symptoms which worsen on contact.
3. Rhus Tox – One of the best Medicines for Postherpetic Neuralgia
Rhus Tox also figures on the list of highly effective medicines for postherpetic neuralgia. It is one of the best medicines for postherpetic neuralgia where the pains are attended with marked restlessness. The skin is sensitive to cold air in such cases. In herpes zoster, Rhus Tox is the most preferred among medicines when the vesicles are yellowish with itching and stinging.