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Post Herpetic Neuralgia
Persistent Nerve Pain as a Result of Herpes
Neuralgia is pain that occurs along the path of the nerves. This condition is best known in relation to
Shingles (Varicella Zoster Virus). Although it has been little studied in connection with genital Herpes
infection, the incidence of this condition is much more common that is normally reported. This type of
neuralgia is the result of the virus irritating the nerves and neural pathways. The symptoms are similar
to Prodrome, including tingling, twitching, burning sensations, shooting pains, numbness, and/or aches
in the area of infection, and also particularly in the buttocks, legs, and thighs. (*Experts advise that
patients experiencing prodromal symptoms or PHN consider the virus to be active, and to take
precautions against transmission.)
The pain can be intermittent, and in some people it can be chronic, lasting for weeks and months at a
time. This kind of chronic HSV-PHN is considered to be rare, although anecdotal evidence suggests
that it occurs much more frequently than has been documented. HSV can also cause a "sciatica
syndrome" - pain the sciatic nerve in the back of the thigh. Many women have found that PHN
intensifies prior to menstruation.
Anti-Viral Drug Therapy for PHN
Some people have found a course of suppressive anti-viral drug therapy to be helpful, particularly when
accompanied by very frequent or severe outbreaks. Acyclovir and other anti- herpes medications work
by interrupting the new viral replication. By keeping the virus in check, theoretically the nerves are able
to calm down and rest after having been irritated for so long. There is some conflicting advice on the
effectiveness of suppressive therapy with acyclovir (Zovirax). Some research from the mid-90s indicated
that it either has no effect, or that it may worsen "unexplained nonlesional HSV episodes." However,
other research and anecdotal reports from Herpesite correspondents found that daily suppressive
therapy with acyclovir brings relief from PHN, possibly by decreasing the irritation to the nerves caused
by frequent outbreaks. Relief may take weeks or even months to achieve, depending on various factors
including the severity and duration of the irritation, and it's effectiveness appears to increase
dramatically by being very regular in the timing of the dosage.
Low-Level AntiDepressant Medications as Therapy for PHN
Elavil, as well as certain other tricyclic antidepressant medications, have pain reduction properties that
appear to be independent of their antidepressant actions, and have been recommended and used for
PHN associated with Shingles. The pain alleviation effect can be reached at doses much smaller than
those normally required for the antidepressant value. Several medical reference books mention these
drugs for "post-herpetic neuralgia" specifically. The drugs mentioned as being possibly effective in
relieving neurogenic pain are: imipramine (Tofranil), nortriptyline (Aventyl), amitriptyline (Elavil),
clomipramine, desipramine, doxepin, and trimipramine. Especially the first three. However, there are
many possible side effects to consider when investigating the use of these drugs. Also, if a person is
already taking another type of anti-depressant or any other drug, they may have to go off it for quite a
while before starting a new one, or they could have serious complications. As always, discuss every
aspect of possible treatments and their side effects with your health care provider and do not attempt
this type of treatment without medical supervision.
Topical Anti-Pain Creams with Capsaicin for PHN
Another treatment that has been shown to be very effective in many cases of neuralgic pain
are topical creams containing Capsaicin. Capsaicin is derived from chile peppers, and works by
inhibiting accumulation of "substance P," which sends pain signals from the nerves to the brain. Studies
have been done with shingles PHN that have shown Capsaicin's effectiveness. HerpeSite
correspondents have found this to be a very effective treatment. One brand that was designed
originally and specifically for shingles PHN is "Zostrix" (named after Varicella Zoster Virus, the
herpesvirus that causes chicken pox and shingles!). The main things to remember if choosing to use
one of these creams are: 1) Wash hands immediately after applying, 2) Rub it in gently or it will burn
worse than an outbreak, 3) never put it on mucous membranes, 4) heat and warm water will intensify the
effects (so no sunbathing, showering, or hot baths afterward!), and 5) Capsaicin's benefits are
cumulative, so it may take up to several weeks to achieve full pain-relieving benefits.
Lifestyle and Nutritional Support for PHN
Some people have found that eliminating coffee and other acidic and neuro-stimulant foods, beverages,
and medications has helped in both decreasing PHN and outbreaks. Other lifestyle modifications,
including meditation, guided imagery, yoga, breathing exercises, and moderate aerobic exercise can
help. Better nutrition can also help people manage their overall health, deal with infection and other
physical stresses, and just feel better. Proper and sufficient hydration, increased intake of essential
fatty acids and "good oils," and consuming fruits and vegetables with anti-oxidant properties can lead to
a stronger immune system and better overall health. The healthier a person's mind and body, the better
they are able to cope with infections, and other physical issues. There are also some experts who say
that the neuralgia, like many other aspects of herpesvirus infections, gets better by itself with time.
The good news is that with time and taking good care of yourself, most people find
that neuralgia, like other aspects of Herpes infections, gets better, with fewer and
milder occurrences. So that's something to look forward to! More tips on how to
improve your physical and emotional well-being to support a healthy and strong
immune system can be found on the Health&Wellness page of HerpeSite.
Persistent Nerve Pain as a Result of Herpes
Neuralgia is pain that occurs along the path of the nerves. This condition is best known in relation to
Shingles (Varicella Zoster Virus). Although it has been little studied in connection with genital Herpes
infection, the incidence of this condition is much more common that is normally reported. This type of
neuralgia is the result of the virus irritating the nerves and neural pathways. The symptoms are similar
to Prodrome, including tingling, twitching, burning sensations, shooting pains, numbness, and/or aches
in the area of infection, and also particularly in the buttocks, legs, and thighs. (*Experts advise that
patients experiencing prodromal symptoms or PHN consider the virus to be active, and to take
precautions against transmission.)
The pain can be intermittent, and in some people it can be chronic, lasting for weeks and months at a
time. This kind of chronic HSV-PHN is considered to be rare, although anecdotal evidence suggests
that it occurs much more frequently than has been documented. HSV can also cause a "sciatica
syndrome" - pain the sciatic nerve in the back of the thigh. Many women have found that PHN
intensifies prior to menstruation.
Anti-Viral Drug Therapy for PHN
Some people have found a course of suppressive anti-viral drug therapy to be helpful, particularly when
accompanied by very frequent or severe outbreaks. Acyclovir and other anti- herpes medications work
by interrupting the new viral replication. By keeping the virus in check, theoretically the nerves are able
to calm down and rest after having been irritated for so long. There is some conflicting advice on the
effectiveness of suppressive therapy with acyclovir (Zovirax). Some research from the mid-90s indicated
that it either has no effect, or that it may worsen "unexplained nonlesional HSV episodes." However,
other research and anecdotal reports from Herpesite correspondents found that daily suppressive
therapy with acyclovir brings relief from PHN, possibly by decreasing the irritation to the nerves caused
by frequent outbreaks. Relief may take weeks or even months to achieve, depending on various factors
including the severity and duration of the irritation, and it's effectiveness appears to increase
dramatically by being very regular in the timing of the dosage.
Low-Level AntiDepressant Medications as Therapy for PHN
Elavil, as well as certain other tricyclic antidepressant medications, have pain reduction properties that
appear to be independent of their antidepressant actions, and have been recommended and used for
PHN associated with Shingles. The pain alleviation effect can be reached at doses much smaller than
those normally required for the antidepressant value. Several medical reference books mention these
drugs for "post-herpetic neuralgia" specifically. The drugs mentioned as being possibly effective in
relieving neurogenic pain are: imipramine (Tofranil), nortriptyline (Aventyl), amitriptyline (Elavil),
clomipramine, desipramine, doxepin, and trimipramine. Especially the first three. However, there are
many possible side effects to consider when investigating the use of these drugs. Also, if a person is
already taking another type of anti-depressant or any other drug, they may have to go off it for quite a
while before starting a new one, or they could have serious complications. As always, discuss every
aspect of possible treatments and their side effects with your health care provider and do not attempt
this type of treatment without medical supervision.
Topical Anti-Pain Creams with Capsaicin for PHN
Another treatment that has been shown to be very effective in many cases of neuralgic pain
are topical creams containing Capsaicin. Capsaicin is derived from chile peppers, and works by
inhibiting accumulation of "substance P," which sends pain signals from the nerves to the brain. Studies
have been done with shingles PHN that have shown Capsaicin's effectiveness. HerpeSite
correspondents have found this to be a very effective treatment. One brand that was designed
originally and specifically for shingles PHN is "Zostrix" (named after Varicella Zoster Virus, the
herpesvirus that causes chicken pox and shingles!). The main things to remember if choosing to use
one of these creams are: 1) Wash hands immediately after applying, 2) Rub it in gently or it will burn
worse than an outbreak, 3) never put it on mucous membranes, 4) heat and warm water will intensify the
effects (so no sunbathing, showering, or hot baths afterward!), and 5) Capsaicin's benefits are
cumulative, so it may take up to several weeks to achieve full pain-relieving benefits.
Lifestyle and Nutritional Support for PHN
Some people have found that eliminating coffee and other acidic and neuro-stimulant foods, beverages,
and medications has helped in both decreasing PHN and outbreaks. Other lifestyle modifications,
including meditation, guided imagery, yoga, breathing exercises, and moderate aerobic exercise can
help. Better nutrition can also help people manage their overall health, deal with infection and other
physical stresses, and just feel better. Proper and sufficient hydration, increased intake of essential
fatty acids and "good oils," and consuming fruits and vegetables with anti-oxidant properties can lead to
a stronger immune system and better overall health. The healthier a person's mind and body, the better
they are able to cope with infections, and other physical issues. There are also some experts who say
that the neuralgia, like many other aspects of herpesvirus infections, gets better by itself with time.
The good news is that with time and taking good care of yourself, most people find
that neuralgia, like other aspects of Herpes infections, gets better, with fewer and
milder occurrences. So that's something to look forward to! More tips on how to
improve your physical and emotional well-being to support a healthy and strong
immune system can be found on the Health&Wellness page of HerpeSite.
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