Materiały źródłowe

• #1 Postherpetic neuralgia – UpToDate

  https://www.uptodate.com/contents/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a condition characterized by focal nerve pain that occurs or persists ≥90 days after the onset of an episode of acute herpes zoster virus reactivation (shingles). […] This topic will review the pathophysiology, clinical presentation, diagnosis, and management of PHN. […] The clinical manifestations, diagnosis, prevention, and treatment of acute herpes zoster reactivation (shingles) are discussed separately. […] PHN symptoms may be persistent and severe, leading to impairments in quality of life. […] Diagnostic testing […] Differential diagnosis […] Other causes of neuropathic facial pain […] Other causes of neuropathic pain in the trunk and extremities […] Recurrent herpes zoster.

• #2 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html

  Herpes zoster, or shingles, is caused by reactivation of varicella zoster virus, which causes chickenpox. Postherpetic neuralgia is the most common complication, occurring in about one in five patients. It is defined as pain in a dermatomal distribution sustained for at least 90 days after acute herpes zoster. […] Although herpes zoster typically is diagnosed clinically, if laboratory confirmation is needed, polymerase chain reaction testing of vesicle or other fluids is preferred for diagnosis because of its high sensitivity (95%) and specificity (100%). […] The diagnosis of herpes zoster is typically clinical. Although herpes zoster is difficult to identify during the prodrome, the appearance of the typical exanthem aids in diagnosis. Testing is typically not needed, but it may be considered in patients with recurring lesions that are suspicious for herpes simplex, or in those with suspected zoster sine herpete, in which the virus causes pain without lesions. Testing may also be considered in atypical presentations, such as the widely disseminated lesions that may occur in immunocompromised patients. Testing is also helpful in differentiating herpes zoster from other vesicular dermatoses, such as contact dermatitis and dermatitis herpetiformis. Polymerase chain reaction testing of vesicle or other body fluids is preferred because of its high sensitivity and specificity (95% and 100%, respectively) and short turnaround (typically one day).

• #3 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  Postherpetic neuralgia (PHN) is the most common long-term complication of varicella-zoster virus (VZV) reactivation. […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical. […] However, laboratory tests and some targeted imaging may provide a degree of utility.

• #4 Clinical Features of Shingles (Herpes Zoster) | Shingles (Herpes Zoster) | CDC

  https://www.cdc.gov/shingles/hcp/clinical-signs/index.html

  Postherpetic neuralgia (PHN) the most common complication of herpes zoster. […] PHN is the most common complication of herpes zoster. PHN is pain that persists in the area where the rash once was located; and continues more than 90 days after rash onset. PHN can last for months or even years. […] Approximately 10% to 18% of people with herpes zoster will have PHN.

• #5 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is usually diagnosed based on your symptoms, history of having shingles and physical exam. If you’ve had a recent case of shingles and have pain in the area where the shingles rash once was, you likely have PHN. Your provider may want to make sure your pain is not caused by something else, but in most cases, no other tests are needed. […] Postherpetic neuralgia (PHN) results from damage to nerve fibers during shingles infection. The nerve fibers at the skin in the affected area send exaggerated pain signals to your brain. Postherpetic neuralgia means nerve pain after herpes. Shingles is also called herpes zoster. […] Common postherpetic neuralgia symptoms include: Burning, sharp, jagging or aching pain in the area where the shingles rash appeared. […] Postherpetic neuralgia (PHN) can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.

• #6 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #7 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  Postherpetic neuralgia (PHN) is the most common long-term complication of varicella-zoster virus (VZV) reactivation. […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical. […] However, laboratory tests and some targeted imaging may provide a degree of utility.

• #8 Postherpetic Neuralgia: Symptoms, Causes, and More

  https://www.healthline.com/health/postherpetic-neuralgia

  Postherpetic neuralgia is a painful complication of shingles that affects the nerves. It results in painful sensations that continue after the rash has healed. […] Most of the time, a doctor can make a diagnosis of postherpetic neuralgia based on how long you’ve experienced pain following shingles. Tests are not often needed to confirm the diagnosis. Some doctors may recommend an MRI or spinal fluid analysis. […] Treatment for postherpetic neuralgia typically involves topical and oral pain relief medications. Doctors may also prescribe other medications to relieve nerve pain, including antidepressants and anticonvulsants. […] Postherpetic neuralgia can last for months to years. Treatment may help reduce pain. […] Postherpetic neuralgia is treatable and preventable. Most pain lessens over time. In rare cases, it can last longer than a year.

• #9 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  Postherpetic neuralgia can cause: Tiredness. Trouble sleeping (insomnia). Decreased appetite. Poor concentration. […] If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed. […] Although there is no cure for PHN, it can be treated. For most people with PHN, pain improves with time and eventually goes away. For most people, the pain goes away in one to three months.

• #10 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  Postherpetic neuralgia (PHN) is the most common long-term complication of varicella-zoster virus (VZV) reactivation. […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical. […] However, laboratory tests and some targeted imaging may provide a degree of utility.

• #11 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  Postherpetic neuralgia is the most common long-term complication of varicella-zoster virus (VZV) reactivation, also known as human herpesvirus-3 (HHV-3). […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Therefore, a history of rash with blisters in a dermatomal pattern could be established. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical.

• #12 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #13 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #14 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  Postherpetic neuralgia (PHN) is the most common long-term complication of varicella-zoster virus (VZV) reactivation. […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical. […] However, laboratory tests and some targeted imaging may provide a degree of utility.

• #15 Postherpetic neuralgia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593

  Your health care provider will check your skin. They might touch the skin in different places to find the borders of the affected area. […] In most cases, no tests are needed. […] For postherpetic neuralgia, questions to ask your doctor include: How long might my symptoms last? What treatment do you suggest? And are there other choices? […] Your doctor is likely to ask you questions such as: Do your symptoms happen some or all the time? How bad are your symptoms? Have you had chickenpox? When? Have you had a shingles vaccine? What, if anything, seems to improve your symptoms? What, if anything, seems to make your symptoms worse?

• #16 SciELO Brazil – Post-herpetic neuralgia Post-herpetic neuralgia

  https://www.scielo.br/j/rdor/a/YFbPSkSpPKCMFp4krg3rvzr/

  Post-herpetic neuralgia is defined as pain persisting for more than three months after the resolution of skin eruptions observed in herpes-zoster. […] Diagnosis of post-herpetic neuralgia is largely clinical and treatment involves an early-stage, multimodal approach. […] PHN diagnosis is predominantly clinical. History of HZ and persistent pain in affected dermatome defines this clinical entity. […] It is important to emphasize that complete PHN diagnosis involves the observation of its impact on quality of life. […] Diagnostic tests have limited application in the clinical management of PHN patients. […] PHN prevention is closely related to HZ prevention.

• #17 Postherpetic neuralgia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593

  Your health care provider will check your skin. They might touch the skin in different places to find the borders of the affected area. […] In most cases, no tests are needed. […] For postherpetic neuralgia, questions to ask your doctor include: How long might my symptoms last? What treatment do you suggest? And are there other choices? […] Your doctor is likely to ask you questions such as: Do your symptoms happen some or all the time? How bad are your symptoms? Have you had chickenpox? When? Have you had a shingles vaccine? What, if anything, seems to improve your symptoms? What, if anything, seems to make your symptoms worse?

• #18 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #19 Postherpetic neuralgia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593

  Your health care provider will check your skin. They might touch the skin in different places to find the borders of the affected area. […] In most cases, no tests are needed. […] For postherpetic neuralgia, questions to ask your doctor include: How long might my symptoms last? What treatment do you suggest? And are there other choices? […] Your doctor is likely to ask you questions such as: Do your symptoms happen some or all the time? How bad are your symptoms? Have you had chickenpox? When? Have you had a shingles vaccine? What, if anything, seems to improve your symptoms? What, if anything, seems to make your symptoms worse?

• #20 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #21

  https://www.painscale.com/article/diagnosing-postherpetic-neuralgia

  Postherpetic neuralgia is a painful condition that can develop as a medical complication of shingles (herpes zoster virus). It presents as a burning pain in the nerves and skin after the rash and blisters from the shingles virus have healed. […] The pain associated with shingles normally ceases after the herpes zoster virus becomes dormant again; however, if pain lingers after the shingles rash disappears, postherpetic neuralgia has likely developed. When an individual has postherpetic neuralgia, nerves that were damaged during an outbreak of shingles send faulty pain signals to the brain. […] Individuals experiencing severe pain in the same location where the shingles rash was located will most likely be diagnosed as having postherpetic neuralgia. A misdiagnosis of postherpetic neuralgia is rare. A health care professional bases the diagnosis of postherpetic neuralgia on an individuals symptoms; further testing is not usually necessary. The diagnostic process typically includes the following: Examining the skin, Determining the border of the affected area, Obtaining a medical history, Clarifying the time frame of the pain, Identifying symptoms (burning, aching, shooting or stinging pain; touch sensitivity; itching or numbness).

• #22 Postherpetic neuralgia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593

  Your health care provider will check your skin. They might touch the skin in different places to find the borders of the affected area. […] In most cases, no tests are needed. […] For postherpetic neuralgia, questions to ask your doctor include: How long might my symptoms last? What treatment do you suggest? And are there other choices? […] Your doctor is likely to ask you questions such as: Do your symptoms happen some or all the time? How bad are your symptoms? Have you had chickenpox? When? Have you had a shingles vaccine? What, if anything, seems to improve your symptoms? What, if anything, seems to make your symptoms worse?

• #23 Postherpetic Neuralgia – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/herpesvirus-infections/postherpetic-neuralgia

  Postherpetic neuralgia diagnosis is usually based on symptoms and results of a physical examination in people who have had shingles. […] If people who have had shingles continue to have pain in the area affected by shingles, they should see a doctor.

• #24 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). […] Results of cerebrospinal fluid (CSF) analysis are abnormal in 61% of patients. […] Small-scale studies suggest that magnetic resonance imaging (MRI) may hold promise for diagnosing challenging PHN cases and differentiating between PHN and HZ. […] Therefore, an anatomical derangement is likely at least partially responsible for the development of PHN. […] The exact physiology that separates a self-limited zoster outbreak from postherpetic neuralgia is not fully understood.

• #25 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  However, laboratory tests and some targeted imaging may provide a degree of utility. […] A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). […] Results of cerebrospinal fluid (CSF) analysis are abnormal in 61% of patients. […] Small-scale studies suggest that magnetic resonance imaging (MRI) may hold promise for diagnosing challenging PHN cases and differentiating between PHN and HZ. […] The first is prevention, which focuses on identifying populations at risk for contracting HZ and administering a vaccine. […] The second is early recognition and treatment of an acute HZ infection, as delay may increase the chance of developing PHN. […] The third approach is symptom management of PHN via multimodal medication regimens and interventional procedures.

• #26 Postherpetic Neuralgia Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/1143066-workup

  In most cases of postherpetic neuralgia (PHN), no laboratory work is necessary. […] Evaluation of cerebrospinal fluid (CSF) yields abnormal findings in 61% of patients. Pleocytosis is observed in 46%, elevated protein in 26%, and varicella zoster virus (VZV) DNA in 22%. However, these findings do not predict the clinical course of PHN. […] Viral culture or immunofluorescent staining may be used to differentiate herpes simplex virus (HSV) infection from herpes zoster (HZ) in cases where it is difficult to distinguish the two conditions from each other on clinical grounds. […] Antibodies to VZV can be measured. A fourfold increase in these antibodies has been used to support the diagnosis of subclinical HZ (zoster sine herpete). However, a rising titer that is secondary to viral exposure rather than reactivation cannot be ruled out.

• #27 Herpes Zoster and Post-Herpetic Neuralgia—Diagnosis, Treatment, and Vaccination Strategies

  https://www.mdpi.com/2076-0817/13/7/596

  Herpes zoster is a clinical diagnosis, especially once the typical cutaneous features are present. However, in immunocompromised patients, the presentation may be atypical. An important differential diagnosis to consider is herpes simplex virus infection. […] When laboratory investigation is indicated, polymerase chain reaction (PCR) testing is preferred (>95% sensitive, 99% specific) and can be used for both cutaneous and non-cutaneous manifestations. Vesicles or erosions seen in cutaneous infections should be swabbed and sent for PCR testing. In non-cutaneous infections, PCR should be performed on the fluids of the organ involvement (e.g., cerebrospinal fluid in meningitis or vitreous samples in acute retinal necrosis). […] The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Antivirals should be started early, preferably within 72 h of the onset of herpes zoster to reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. […] Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of PHN to reduce its incidence.

• #28 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html

  Herpes zoster, or shingles, is caused by reactivation of varicella zoster virus, which causes chickenpox. Postherpetic neuralgia is the most common complication, occurring in about one in five patients. It is defined as pain in a dermatomal distribution sustained for at least 90 days after acute herpes zoster. […] Although herpes zoster typically is diagnosed clinically, if laboratory confirmation is needed, polymerase chain reaction testing of vesicle or other fluids is preferred for diagnosis because of its high sensitivity (95%) and specificity (100%). […] The diagnosis of herpes zoster is typically clinical. Although herpes zoster is difficult to identify during the prodrome, the appearance of the typical exanthem aids in diagnosis. Testing is typically not needed, but it may be considered in patients with recurring lesions that are suspicious for herpes simplex, or in those with suspected zoster sine herpete, in which the virus causes pain without lesions. Testing may also be considered in atypical presentations, such as the widely disseminated lesions that may occur in immunocompromised patients. Testing is also helpful in differentiating herpes zoster from other vesicular dermatoses, such as contact dermatitis and dermatitis herpetiformis. Polymerase chain reaction testing of vesicle or other body fluids is preferred because of its high sensitivity and specificity (95% and 100%, respectively) and short turnaround (typically one day).

• #29 Post-herpetic neuralgia: Diagnosis and management options – Medical Independent

  https://www.medicalindependent.ie/societies/isr/post-herpetic-neuralgia-diagnosis-and-management-options/

  Results of cerebrospinal fluid (CSF) analysis are abnormal in 61 per cent of patients. Pleocytosis, elevated protein, and VZV DNA are usually seen. Viral culture or immunofluorescent staining helps distinguish herpes simplex from HZ. […] Small-scale studies suggest that MRI may hold promise for diagnosing challenging PHN cases and differentiating between PHN and HZ. A study by Haanpaa et al reported that MRI revealed lesions attributable to HZ in the cervical cord and the brain stem in nine patients (56 per cent). At three months after the onset of HZ, PHN developed in five patients (56 per cent) who had an abnormal MRI. On MRI, seven patients with no HZ lesions did not develop residual pain.

• #30 Postherpetic Neuralgia Workup: Laboratory Studies, Imaging Studies, Histologic Findings

  https://emedicine.medscape.com/article/1143066-workup

  A study by Haanpaa et al revealed the following findings from magnetic resonance imaging (MRI): MRI lesions attributable to HZ were seen in the brainstem and cervical cord in nine (56%) of 16 patients. […] At 3 months after the onset of HZ, five (56%) of the nine patients with an abnormal MRI had developed PHN. […] Of the seven patients who had no HZ-related lesions on MRI, none had residual pain. […] Although HZ symptoms may be confined to a few sensory dermatomes, pathologic changes may be more widespread. Affected ganglia of the spinal or cranial nerve roots are swollen and inflamed with a primarily lymphocytic reaction. Some ganglion cells are swollen while others are degenerated. […] In the months following infection, fibrosis occurs in the ganglia, peripheral nerve, and nerve root. Degeneration occurs in the ipsilateral posterior column.

• #31

  https://link.springer.com/article/10.1007/s40122-023-00510-4

  High-frequency ultrasound diagnosis can detect pathological changes, such as demyelination or edema of the affected nerve roots, and combined with clinical symptoms, it can improve the accuracy of diagnosis. […] At present, most of the clinical proteomic analysis and non-coding RNA research are focused on patients diagnosed with shingles. However, future studies should focus on patients who develop shingles and PHN before the onset of rash.

• #32 Post-herpetic neuralgia – Pathos

  https://www.pathos-journal.com/2024_1_246.html

  Post-herpetic neuralgia (PHN) is of particular interest to the algologist because it can be produced by all the pathogenetic mechanisms of neuropathic pain, singly or variously associated. […] In the chapter of neuropathic pain, post-herpetic neuralgia (PHN) is a very special condition because, far from being a single entity, all the pathogenetic types of neuropathic pain are possible in it, either singly or variously represented, causing the clinical picture to vary in severity, conditioning the prognosis and complicating therapy. […] Clinically, to recognise the pathogenic type of PHN, we can refer to a number of criteria, which are: topographical distribution of pain, presence and type of sensory deficit, presence of allodynia and character of the pain intensity pattern. […] It is worth starting the diagnostic reasoning from the criterion of the topographical distribution of pain, which can be local, metameric, peripheral or plurimetameric.

• #33 Post-herpetic neuralgia – Pathos

  https://www.pathos-journal.com/2024_1_246.html

  If the topographic distribution of pain is metameric, it is Type II or III PHN. […] Allodynia is present in Type II PHN and not in Type III PHN. […] Finally, if the topographic distribution of pain is plurimetameric, it is Type IV PHN (Central) which is associated with anaesthesia without allodynia because there are no C or A afferents capable of causing it.

• #34 Post-herpetic neuralgia – Pathos

  https://www.pathos-journal.com/2024_1_246.html

  If the topographic distribution of pain is metameric, it is Type II or III PHN. […] Allodynia is present in Type II PHN and not in Type III PHN. […] Finally, if the topographic distribution of pain is plurimetameric, it is Type IV PHN (Central) which is associated with anaesthesia without allodynia because there are no C or A afferents capable of causing it.

• #35 Post-herpetic neuralgia – Pathos

  https://www.pathos-journal.com/2024_1_246.html

  If the topographic distribution of pain is metameric, it is Type II or III PHN. […] Allodynia is present in Type II PHN and not in Type III PHN. […] Finally, if the topographic distribution of pain is plurimetameric, it is Type IV PHN (Central) which is associated with anaesthesia without allodynia because there are no C or A afferents capable of causing it.

• #36 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #37 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #38 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #39 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #40 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #41 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #42 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #43 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #44 Postherpetic neuralgia – UpToDate

  https://www.uptodate.com/contents/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a condition characterized by focal nerve pain that occurs or persists ≥90 days after the onset of an episode of acute herpes zoster virus reactivation (shingles). […] This topic will review the pathophysiology, clinical presentation, diagnosis, and management of PHN. […] The clinical manifestations, diagnosis, prevention, and treatment of acute herpes zoster reactivation (shingles) are discussed separately. […] PHN symptoms may be persistent and severe, leading to impairments in quality of life. […] Diagnostic testing […] Differential diagnosis […] Other causes of neuropathic facial pain […] Other causes of neuropathic pain in the trunk and extremities […] Recurrent herpes zoster.

• #45 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  In the diagnosis of PHN, routine questioning should attempt to identify the nature of the patients pain. […] Pain following a documented episode of AHZ provides compelling evidence for a diagnosis of PHN. […] The patient history may reveal conditions that may help differentially diagnosis PHN, including a recent history or the presence of herpes simplex virus, impetigo, candidiasis, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis and drug-related eruptions. […] Nevertheless, pain following a documented episode of AHZ usually provides clear evidence for a diagnosis of PHN. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #46

  https://link.springer.com/article/10.1007/s40266-012-0014-3

  This evidence may be particularly compelling when additional PHN risk factors are present, including advanced age, severe prodromal pain, severe rash, AHZ localized in the trigeminal dermatomes and brachial plexus, and symptoms of allodynia. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #47 Postherpetic Neuralgia Symptoms, Diagnosis, & Treatment

  https://www.emedicinehealth.com/how_do_i_know_if_i_have_postherpetic_neuralgia/article_em.htm

  Postherpetic neuralgia is a complication of a painful rash called shingles, which is caused by the varicella-zoster virus (the same virus that causes chickenpox). If you have been diagnosed with shingles and the rash has gone away, but pain persists, you may have postherpetic neuralgia. […] Most of the time, postherpetic neuralgia is easy to diagnose because it results from pain that persists after a documented case of shingles. The diagnosis is made based on the clinical presentation alone. […] Factors that can support a diagnosis of postherpetic neuralgia include: Advanced age (postherpetic neuralgia is common in people aged 50 years and older), severe prodromal pain with acute herpes zoster, severe rash that preceded the pain, distribution of pain in certain areas of skin supplied by specific nerves (trigeminal or brachial plexus dermatomes), the presence of pain on light touch.

• #48

  https://link.springer.com/article/10.1007/s40266-012-0014-3

  This evidence may be particularly compelling when additional PHN risk factors are present, including advanced age, severe prodromal pain, severe rash, AHZ localized in the trigeminal dermatomes and brachial plexus, and symptoms of allodynia. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #49

  https://link.springer.com/article/10.1007/s40266-012-0014-3

  This evidence may be particularly compelling when additional PHN risk factors are present, including advanced age, severe prodromal pain, severe rash, AHZ localized in the trigeminal dermatomes and brachial plexus, and symptoms of allodynia. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #50

  https://link.springer.com/article/10.1007/s40266-012-0014-3

  This evidence may be particularly compelling when additional PHN risk factors are present, including advanced age, severe prodromal pain, severe rash, AHZ localized in the trigeminal dermatomes and brachial plexus, and symptoms of allodynia. […] During the physical examination, areas of previous AHZ may show evidence of cutaneous scarring. […] In approximately 50 % of patients with PHN, dynamic mechanical allodynia occurs in the pain-producing area in response to normally nonpainful stimuli, such as light touch by a brush.

• #51 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. […] Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. […] Despite the potentially debilitating nature of this disorder, PHN tends to be underdiagnosed and inadequately managed, especially in primary care. […] This review provides essential information that will enable clinicians to correctly diagnosis PHN and select the most appropriate pharmacotherapy for their patients with PHN. […] Although AHZ is typically easily recognizable, PHN can be difficult to diagnose because a patient with pain long after the AHZ rash has cleared up may not remember the rash or associate the current pain with it.

• #52 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  However, laboratory tests and some targeted imaging may provide a degree of utility. […] A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). […] Results of cerebrospinal fluid (CSF) analysis are abnormal in 61% of patients. […] Small-scale studies suggest that magnetic resonance imaging (MRI) may hold promise for diagnosing challenging PHN cases and differentiating between PHN and HZ. […] The first is prevention, which focuses on identifying populations at risk for contracting HZ and administering a vaccine. […] The second is early recognition and treatment of an acute HZ infection, as delay may increase the chance of developing PHN. […] The third approach is symptom management of PHN via multimodal medication regimens and interventional procedures.

• #53 Postherpetic Neuralgia Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following an outbreak of varicella zoster virus (VSV), or shingles. […] Not everyone whos had a reactivation of the virus develops postherpetic neuralgia. But postherpetic neuralgia is a common complication of shingles in older adults. […] In most people, the pain of postherpetic neuralgia lessens over time. […] See a doctor at the first sign of shingles. Treating shingles earlywithin three days of developing the rashwith oral antiviral drugs may actually prevent PHN. If you do develop PHN, see your doctor right away. […] Once PHN has occurred, a comprehensive, multidisciplinary pain management-oriented approach is helpful. […] In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few dont receive any relief. […] Although a vaccine to prevent chickenpox is available, its effect on postherpetic neuralgia is unknown. […] The vaccine significantly reduced the severity of the disease and lessened the risk of complications, such as postherpetic neuralgia.

• #54 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588

  Postherpetic neuralgia happens if nerve fibers get damaged during an outbreak of shingles. Damaged fibers can’t send messages from the skin to the brain as they usually do. Instead, the messages become confused and heightened. This causes pain that can last months or even years. […] See a health care provider at the first sign of shingles. Often the pain starts before you notice a rash. The risk of postherpetic neuralgia becomes lower if you start taking virus-fighting medicines called antivirals within 72 hours of getting the shingles rash. […] Shingles vaccines can help prevent shingles and postherpetic neuralgia. Ask your health care provider when you should get a vaccine.

• #55 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  Postherpetic neuralgia can cause: Tiredness. Trouble sleeping (insomnia). Decreased appetite. Poor concentration. […] If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed. […] Although there is no cure for PHN, it can be treated. For most people with PHN, pain improves with time and eventually goes away. For most people, the pain goes away in one to three months.

• #56 Postherpetic neuralgia | ABC Medical Center

  https://centromedicoabc.com/en/padecimientos/postherpetic-neuralgia/

  Once your doctor analyzes your symptoms and clinical history, they will perform a physical examination on the skin to confirm the diagnosis. […] Postherpetic neuralgia treatment consists of a combination of drugs that help reduce pain and control symptoms, such as: Painkillers. Anticonvulsants. Antidepressants. Steroids. Psychotherapy. […] The vaccine is recommended to prevent shingles and postherpetic neuralgia in older adults.

• #57

  https://link.springer.com/article/10.1007/s40122-023-00510-4

  Early intervention reduces the incidence of postherpetic neuralgia (PHN). […] There is no clear diagnostic method for neuralgia symptoms manifested before the onset of the rash, which can easily cause misdiagnosis. […] The early diagnosis of herpes zoster neuralgia can reduce misdiagnosis and mistreatment, and timely and effective intervention can significantly reduce the incidence of PHN. […] Early diagnosis of HZ neuralgia before eruption can facilitate timely targeted treatment, thereby reducing the incidence of PHN. […] Proteomic quantitative analysis and validation results can serve as a simple, micro, rapid, and accurate diagnostic method. […] Patients with HZ require prompt diagnoses and treatment to avoid severe progression to postherpetic neuralgia (PHN). […] Misdiagnosis not only increases the patients pain, medical expenses, and mental burden, but more importantly, delays the valuable time for early treatment of shingles and increases the risk of complications and PHN.

• #58

  https://link.springer.com/article/10.1007/s40122-023-00510-4

  Early intervention reduces the incidence of postherpetic neuralgia (PHN). […] There is no clear diagnostic method for neuralgia symptoms manifested before the onset of the rash, which can easily cause misdiagnosis. […] The early diagnosis of herpes zoster neuralgia can reduce misdiagnosis and mistreatment, and timely and effective intervention can significantly reduce the incidence of PHN. […] Early diagnosis of HZ neuralgia before eruption can facilitate timely targeted treatment, thereby reducing the incidence of PHN. […] Proteomic quantitative analysis and validation results can serve as a simple, micro, rapid, and accurate diagnostic method. […] Patients with HZ require prompt diagnoses and treatment to avoid severe progression to postherpetic neuralgia (PHN). […] Misdiagnosis not only increases the patients pain, medical expenses, and mental burden, but more importantly, delays the valuable time for early treatment of shingles and increases the risk of complications and PHN.

• #59

  https://link.springer.com/article/10.1007/s40122-023-00510-4

  Early intervention reduces the incidence of postherpetic neuralgia (PHN). […] There is no clear diagnostic method for neuralgia symptoms manifested before the onset of the rash, which can easily cause misdiagnosis. […] The early diagnosis of herpes zoster neuralgia can reduce misdiagnosis and mistreatment, and timely and effective intervention can significantly reduce the incidence of PHN. […] Early diagnosis of HZ neuralgia before eruption can facilitate timely targeted treatment, thereby reducing the incidence of PHN. […] Proteomic quantitative analysis and validation results can serve as a simple, micro, rapid, and accurate diagnostic method. […] Patients with HZ require prompt diagnoses and treatment to avoid severe progression to postherpetic neuralgia (PHN). […] Misdiagnosis not only increases the patients pain, medical expenses, and mental burden, but more importantly, delays the valuable time for early treatment of shingles and increases the risk of complications and PHN.

• #60 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  However, laboratory tests and some targeted imaging may provide a degree of utility. […] A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). […] Results of cerebrospinal fluid (CSF) analysis are abnormal in 61% of patients. […] Small-scale studies suggest that magnetic resonance imaging (MRI) may hold promise for diagnosing challenging PHN cases and differentiating between PHN and HZ. […] The first is prevention, which focuses on identifying populations at risk for contracting HZ and administering a vaccine. […] The second is early recognition and treatment of an acute HZ infection, as delay may increase the chance of developing PHN. […] The third approach is symptom management of PHN via multimodal medication regimens and interventional procedures.

• #61 Post Herpetic Neuralgia ICD-10-CM Codes | 2023

  https://www.carepatron.com/icd/post-herpetic-neuralgia

  Postherpetic neuralgia (PHN) is a severe, long-lasting pain that can persist after an episode of shingles. It represents one of the most common complications of the disease. The International Classification of Diseases, 10th Edition (ICD-10), provides specific codes for accurately documenting this condition and its various forms. […] These ICD-10 codes are essential for healthcare providers to accurately document the presence of PHN in a patient’s medical record, facilitating communication between different healthcare professionals and playing a critical role in the billing process. […] Postherpetic neuralgia is more than just a lasting pain; it’s a condition that can significantly impact a patient’s quality of life. Thus, understanding these codes and their applications is crucial for the correct diagnosis, treatment planning, and management of this condition. […] An ICD code for postherpetic neuralgia should be used when documenting a confirmed condition diagnosis in a patient’s medical record. […] A diagnosis code for postherpetic neuralgia represents a confirmed medical diagnosis. It is used for documentation, billing, and statistical purposes.

• #62 Post Herpetic Neuralgia ICD-10-CM Codes | 2023

  https://www.carepatron.com/icd/post-herpetic-neuralgia

  Postherpetic neuralgia (PHN) is a severe, long-lasting pain that can persist after an episode of shingles. It represents one of the most common complications of the disease. The International Classification of Diseases, 10th Edition (ICD-10), provides specific codes for accurately documenting this condition and its various forms. […] These ICD-10 codes are essential for healthcare providers to accurately document the presence of PHN in a patient’s medical record, facilitating communication between different healthcare professionals and playing a critical role in the billing process. […] Postherpetic neuralgia is more than just a lasting pain; it’s a condition that can significantly impact a patient’s quality of life. Thus, understanding these codes and their applications is crucial for the correct diagnosis, treatment planning, and management of this condition. […] An ICD code for postherpetic neuralgia should be used when documenting a confirmed condition diagnosis in a patient’s medical record. […] A diagnosis code for postherpetic neuralgia represents a confirmed medical diagnosis. It is used for documentation, billing, and statistical purposes.

• #63 How to Diagnose Postherpetic Neuralgia Like a Pro – Doctronic, Your Trusted AI Doctor

  https://www.doctronic.ai/conditions-diseases/how-to-diagnose-postherpetic-neuralgia-like-a-pro-P6pyvb

  Diagnosing postherpetic neuralgia (PHN) can be straightforward if you know what to look for. The primary indicator of PHN is pain that persists for more than three months in the same area as a previous shingles rash. Document whether the pain is burning, stabbing, or sensitive to touch (allodynia), as these are key symptoms. Ensure there was a prior episode of shingles, characterized by a rash and acute pain. In cases without a noted rash, consider the possibility of 'zoster sine herpete,’ where the virus reactivates without an obvious rash. Use MRI scans to rule out other conditions like trigeminal neuropathy or diabetic neuropathy. A careful review of symptoms and medical history can help differentiate PHN from similar conditions. Persistent pain in an area previously affected by shingles. Yes, it’s called 'zoster sine herpete.’ MRI scans and medical history are key for confirmation. […] A step-by-step guide to diagnosing postherpetic neuralgia, focusing on identifying persistent pain and confirming a history of shingles.

• #64

  https://link.springer.com/article/10.1007/s40122-023-00510-4

  Early intervention reduces the incidence of postherpetic neuralgia (PHN). […] There is no clear diagnostic method for neuralgia symptoms manifested before the onset of the rash, which can easily cause misdiagnosis. […] The early diagnosis of herpes zoster neuralgia can reduce misdiagnosis and mistreatment, and timely and effective intervention can significantly reduce the incidence of PHN. […] Early diagnosis of HZ neuralgia before eruption can facilitate timely targeted treatment, thereby reducing the incidence of PHN. […] Proteomic quantitative analysis and validation results can serve as a simple, micro, rapid, and accurate diagnostic method. […] Patients with HZ require prompt diagnoses and treatment to avoid severe progression to postherpetic neuralgia (PHN). […] Misdiagnosis not only increases the patients pain, medical expenses, and mental burden, but more importantly, delays the valuable time for early treatment of shingles and increases the risk of complications and PHN.

• #65 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. […] Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. […] Despite the potentially debilitating nature of this disorder, PHN tends to be underdiagnosed and inadequately managed, especially in primary care. […] This review provides essential information that will enable clinicians to correctly diagnosis PHN and select the most appropriate pharmacotherapy for their patients with PHN. […] Although AHZ is typically easily recognizable, PHN can be difficult to diagnose because a patient with pain long after the AHZ rash has cleared up may not remember the rash or associate the current pain with it.

• #66 Post-herpetic neuralgia: Diagnosis and management options – Medical Independent

  https://www.medicalindependent.ie/societies/isr/post-herpetic-neuralgia-diagnosis-and-management-options/

  The diagnosis of PHN is relatively straightforward and not one of exclusion. An episode of HZ is a prerequisite for PHN. Therefore, a history of rash with blisters in a dermatomal pattern would be expected. Rarely the characteristic rash will not be found. Persistent (more than or equal to three months) lancinating/burning pain, allodynia, paraesthesia, pruritus, dysesthesia, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] PHN is almost universally diagnosed based on the history and physical examination. However, laboratory tests and some targeted imaging may provide a degree of utility. These are of greater value in atypical presentations of PHN, such as zoster sine herpete or HZ of the larynx. Serological testing for VZV IgG and IgM titres is possible, although the sensitivity and specificity are less than ideal. A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). However, this rising titre may or may not be secondary to viral exposure or reactivation. Comparatively, immunofluorescence of vesicle scrapings detects VZV antigens in a highly specific and sensitive manner. Similarly, PCR is exquisitely sensitive for the detection of VZV DNA.

• #67 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  The role of opioid analgesics in the management of PHN remains controversial. […] In patients with PHN, first-line systemic therapies, such as tricyclic antidepressants (amitriptyline, nortriptyline and desipramine) and gabapentinoids (gabapentin and pregabalin) have demonstrated efficacy, but may not be the most appropriate therapy for all patients because of their relatively slow onset of action and potential for treatment-limiting systemic adverse events. […] The lidocaine 5 % patch, listed as a first-line therapy in some guidelines, has a rapid onset of pain relief and a minimal risk for systemic adverse events, although application-site reactions occur in a minority of patients. […] In some patients, it may be clinically plausible to initiate the treatment of PHN with a topical agent, such as the lidocaine 5 % patch, before resorting to a systemic therapy, and to switch to or add on a systemic therapy when necessary to achieve satisfactory pain control.

• #68 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  The American Academy of Neurology (AAN), Special Interest Group on Neuropathic Pain (NeuPSIG), and European Federation of Neurological Societies (EFNS) all recommend an oral tricyclic antidepressant (TCA), pregabalin, and the lidocaine 5% patch as first-line therapies. […] There is no one superior treatment regimen; however, expert consensus suggests that multimodal therapy is likely the best approach. […] Neuropathic pain is an umbrella term that describes a type of pain common to many diseases and conditions. […] Nevertheless, unilateral neuropathic pain in a dermatomal pattern at or near the area of a previous HZ rash is highly specific for postherpetic neuralgia. […] Postherpetic neuralgia is challenging to treat. Symptoms may continue for years, sometimes whole life. […] When prevention of HZ is not possible, timely treatment is advisable, as duration and severity of pain are considered risk factors for PHN. […] Therefore, multimodal therapeutic approaches recommended by expert consensus should be considered.

• #69 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  The role of opioid analgesics in the management of PHN remains controversial. […] In patients with PHN, first-line systemic therapies, such as tricyclic antidepressants (amitriptyline, nortriptyline and desipramine) and gabapentinoids (gabapentin and pregabalin) have demonstrated efficacy, but may not be the most appropriate therapy for all patients because of their relatively slow onset of action and potential for treatment-limiting systemic adverse events. […] The lidocaine 5 % patch, listed as a first-line therapy in some guidelines, has a rapid onset of pain relief and a minimal risk for systemic adverse events, although application-site reactions occur in a minority of patients. […] In some patients, it may be clinically plausible to initiate the treatment of PHN with a topical agent, such as the lidocaine 5 % patch, before resorting to a systemic therapy, and to switch to or add on a systemic therapy when necessary to achieve satisfactory pain control.

• #70 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  The American Academy of Neurology (AAN), Special Interest Group on Neuropathic Pain (NeuPSIG), and European Federation of Neurological Societies (EFNS) all recommend an oral tricyclic antidepressant (TCA), pregabalin, and the lidocaine 5% patch as first-line therapies. […] There is no one superior treatment regimen; however, expert consensus suggests that multimodal therapy is likely the best approach. […] Neuropathic pain is an umbrella term that describes a type of pain common to many diseases and conditions. […] Nevertheless, unilateral neuropathic pain in a dermatomal pattern at or near the area of a previous HZ rash is highly specific for postherpetic neuralgia. […] Postherpetic neuralgia is challenging to treat. Symptoms may continue for years, sometimes whole life. […] When prevention of HZ is not possible, timely treatment is advisable, as duration and severity of pain are considered risk factors for PHN. […] Therefore, multimodal therapeutic approaches recommended by expert consensus should be considered.

• #71 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  The role of opioid analgesics in the management of PHN remains controversial. […] In patients with PHN, first-line systemic therapies, such as tricyclic antidepressants (amitriptyline, nortriptyline and desipramine) and gabapentinoids (gabapentin and pregabalin) have demonstrated efficacy, but may not be the most appropriate therapy for all patients because of their relatively slow onset of action and potential for treatment-limiting systemic adverse events. […] The lidocaine 5 % patch, listed as a first-line therapy in some guidelines, has a rapid onset of pain relief and a minimal risk for systemic adverse events, although application-site reactions occur in a minority of patients. […] In some patients, it may be clinically plausible to initiate the treatment of PHN with a topical agent, such as the lidocaine 5 % patch, before resorting to a systemic therapy, and to switch to or add on a systemic therapy when necessary to achieve satisfactory pain control.

• #72 Postherpetic Neuralgia – Symptoms, Treatment & Clinical Trials – Genesis Research Services

  https://genesisresearchservices.com/postherpetic-neuralgia-symptoms-treatment-clinical-trials/

  Certain classes of antidepressants can relieve nerve pain, even if you aren’t experiencing depression. […] Topical treatments are applied directly to the skin over the painful area. […] In cases of severe or acute PHN, slow-release opioids, such as oxycodone, tramadol, or morphine, may be prescribed. […] Interventional therapies offer more advanced treatment options for people who don’t respond to standard treatments and continue to experience pain. […] Clinical trials continue to explore different combinations of drugs and interventional therapies to improve the management of both acute shingles and chronic PHN.

• #73 Herpes Zoster and Post-Herpetic Neuralgia—Diagnosis, Treatment, and Vaccination Strategies

  https://www.mdpi.com/2076-0817/13/7/596

  Herpes zoster is a clinical diagnosis, especially once the typical cutaneous features are present. However, in immunocompromised patients, the presentation may be atypical. An important differential diagnosis to consider is herpes simplex virus infection. […] When laboratory investigation is indicated, polymerase chain reaction (PCR) testing is preferred (>95% sensitive, 99% specific) and can be used for both cutaneous and non-cutaneous manifestations. Vesicles or erosions seen in cutaneous infections should be swabbed and sent for PCR testing. In non-cutaneous infections, PCR should be performed on the fluids of the organ involvement (e.g., cerebrospinal fluid in meningitis or vitreous samples in acute retinal necrosis). […] The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Antivirals should be started early, preferably within 72 h of the onset of herpes zoster to reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. […] Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of PHN to reduce its incidence.

• #74 Postherpetic Neuralgia – Symptoms, Treatment & Clinical Trials – Genesis Research Services

  https://genesisresearchservices.com/postherpetic-neuralgia-symptoms-treatment-clinical-trials/

  Certain classes of antidepressants can relieve nerve pain, even if you aren’t experiencing depression. […] Topical treatments are applied directly to the skin over the painful area. […] In cases of severe or acute PHN, slow-release opioids, such as oxycodone, tramadol, or morphine, may be prescribed. […] Interventional therapies offer more advanced treatment options for people who don’t respond to standard treatments and continue to experience pain. […] Clinical trials continue to explore different combinations of drugs and interventional therapies to improve the management of both acute shingles and chronic PHN.

• #75 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  The American Academy of Neurology (AAN), Special Interest Group on Neuropathic Pain (NeuPSIG), and European Federation of Neurological Societies (EFNS) all recommend an oral tricyclic antidepressant (TCA), pregabalin, and the lidocaine 5% patch as first-line therapies. […] There is no one superior treatment regimen; however, expert consensus suggests that multimodal therapy is likely the best approach. […] Neuropathic pain is an umbrella term that describes a type of pain common to many diseases and conditions. […] Nevertheless, unilateral neuropathic pain in a dermatomal pattern at or near the area of a previous HZ rash is highly specific for postherpetic neuralgia. […] Postherpetic neuralgia is challenging to treat. Symptoms may continue for years, sometimes whole life. […] When prevention of HZ is not possible, timely treatment is advisable, as duration and severity of pain are considered risk factors for PHN. […] Therefore, multimodal therapeutic approaches recommended by expert consensus should be considered.

• #76 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is usually diagnosed based on your symptoms, history of having shingles and physical exam. If you’ve had a recent case of shingles and have pain in the area where the shingles rash once was, you likely have PHN. Your provider may want to make sure your pain is not caused by something else, but in most cases, no other tests are needed. […] Postherpetic neuralgia (PHN) results from damage to nerve fibers during shingles infection. The nerve fibers at the skin in the affected area send exaggerated pain signals to your brain. Postherpetic neuralgia means nerve pain after herpes. Shingles is also called herpes zoster. […] Common postherpetic neuralgia symptoms include: Burning, sharp, jagging or aching pain in the area where the shingles rash appeared. […] Postherpetic neuralgia (PHN) can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.

• #77 Post-herpetic neuralgia

  https://dermnetnz.org/topics/post-herpetic-neuralgia

  Post-herpetic neuralgia is often used to describe any pain that persists after herpes zoster blisters have cleared up. […] Because post-herpetic neuralgia is defined as pain after and caused by, re-activation of the herpes zoster virus, evidence of herpes zoster infection is critical for diagnosis. […] In these cases, a rise in antibody levels on serial blood tests may confirm the previous infection by herpes zoster virus. […] The duration of post-herpetic neuralgia is variable. […] In untreated patients, about half have no pain at 6 months. […] Some experts prefer to reserve the term only for pain that lasts for more than 28 days or more than 120 days. […] Early use of a tricyclic agent may reduce the risk of post-herpetic neuralgia. […] Antiviral agents such as aciclovir reduce the severity and duration of acute symptoms of herpes zoster. […] Even with optimum antiviral therapy, 20-30% of herpes zoster patients develop post-herpetic neuralgia.

• #78 Postherpetic Neuralgia Treatment, Symptoms Shingles, Causes

  https://www.medicinenet.com/postherpetic_neuralgia/article.htm

  How is postherpetic neuralgia diagnosed? The majority of patients who are diagnosed with PHN are done by follow-up of a shingles infection or by the patient’s history of a recent shingles infection. The pain is located in the same nerve distribution (dermatome) area, usually on only one side of the person’s body where the shingles lesions occurred. […] For the majority of patients who develop PHN, the prognosis is good although they may have to take pain medications for about one to three months. For others, the prognosis is fair to poor if the pain is severe, lasts longer than three months, or markedly reduces their quality of life. PHN occasionally results in permanent nerve damage; however, the disease is not fatal.

• #79 Postherpetic Neuralgia | Symptoms and Treatment

  https://patient.info/skin-conditions/shingles-herpes-zoster-leaflet/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a nerve pain (neuralgia) that persists after the shingles rash has cleared. If the pain from shingles goes but then returns at a later date, this too is called PHN. […] Postherpetic neuralgia is not like other pains, such as headaches or toothache. The pain is caused by the nerve endings which were affected by the shingles. These are inflamed or damaged by the infection. Because the pain is arising from the nerve endings, rather than the skin itself, normal painkillers are largely ineffective. Specific drugs may be required which act on the nerve endings themselves. […] For most of the medicines listed above, it is common practice to start at a low dose at first. This may be sufficient to ease the pain but the dose needs to be increased if the effect is not satisfactory. This is usually done gradually and is called titrating the dose. […] The aim is to find the lowest dose required to ease the pain. This is because the lower the dose, the less likely that side-effects will be troublesome.

• #80 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  Postherpetic neuralgia (PHN) is the most common long-term complication of varicella-zoster virus (VZV) reactivation. […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical. […] However, laboratory tests and some targeted imaging may provide a degree of utility.

• #81 Postherpetic Neuralgia | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27517

  Postherpetic neuralgia is the most common long-term complication of varicella-zoster virus (VZV) reactivation, also known as human herpesvirus-3 (HHV-3). […] The hallmark of PHN is a lancinating/burning pain in a unilateral dermatomal pattern that persists for three or more months after the onset of a herpes zoster (HZ) outbreak. […] Unlike other neuropathic conditions, the diagnosis of postherpetic neuralgia is relatively straightforward and not one of exclusion. […] Therefore, a history of rash with blisters in a dermatomal pattern could be established. […] Persistent (more than or equal to 3 months) lancinating/burning pain, allodynia, paresthesias, pruritus, dysesthesias, and/or hyperalgesia at or near the area of the rash is characteristic of PHN. […] Postherpetic neuralgia is almost universally diagnosed based on history and physical.

• #82 Postherpetic Neuralgia Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following an outbreak of varicella zoster virus (VSV), or shingles. […] Not everyone whos had a reactivation of the virus develops postherpetic neuralgia. But postherpetic neuralgia is a common complication of shingles in older adults. […] In most people, the pain of postherpetic neuralgia lessens over time. […] See a doctor at the first sign of shingles. Treating shingles earlywithin three days of developing the rashwith oral antiviral drugs may actually prevent PHN. If you do develop PHN, see your doctor right away. […] Once PHN has occurred, a comprehensive, multidisciplinary pain management-oriented approach is helpful. […] In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few dont receive any relief. […] Although a vaccine to prevent chickenpox is available, its effect on postherpetic neuralgia is unknown. […] The vaccine significantly reduced the severity of the disease and lessened the risk of complications, such as postherpetic neuralgia.

• #83 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588

  Postherpetic neuralgia happens if nerve fibers get damaged during an outbreak of shingles. Damaged fibers can’t send messages from the skin to the brain as they usually do. Instead, the messages become confused and heightened. This causes pain that can last months or even years. […] See a health care provider at the first sign of shingles. Often the pain starts before you notice a rash. The risk of postherpetic neuralgia becomes lower if you start taking virus-fighting medicines called antivirals within 72 hours of getting the shingles rash. […] Shingles vaccines can help prevent shingles and postherpetic neuralgia. Ask your health care provider when you should get a vaccine.

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