Materiały źródłowe

• #1 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 VZV is a double-stranded DNA virus. It lays dormant in the ganglia of certain peripheral and central nerves after an episode of varicella resolves, generally in youth, with the immune system of the host eradicating the virus in most locations within the body. Advancing age combined with a decrease in immunocompetence, usually accompanied by a psychological or physical stressor, may result in reactivation of the dormant/latent VZV as HZ. […] Well-established risk factors for an acute HZ episode progressing to PHN include age, severe immunosuppression, the presence of a prodromal phase, severe pain during zoster outbreak, allodynia, ophthalmic involvement, and diabetes mellitus.

• #2 Postherpetic neuralgia – Wikipedia

  https://en.wikipedia.org/wiki/Postherpetic_neuralgia

  Postherpetic neuralgia (PHN) is neuropathic pain that occurs due to damage to a peripheral nerve caused by the reactivation of the varicella zoster virus (herpes zoster, also known as shingles). PHN is defined as pain in a dermatomal distribution that lasts for at least 90 days after an outbreak of herpes zoster. […] Postherpetic neuralgia is the most common long-term complication of herpes zoster, and occurs in approximately 20% of patients with shingles. Risk factors for PHN include older age, severe prodrome or rash, severe acute zoster pain, ophthalmic involvement, immunosuppression, and chronic conditions such as diabetes mellitus and lupus. […] The nerve pain of PHN is thought to result from damage in a peripheral nerve that was affected by the reactivation of the varicella zoster virus.

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

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

  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. […] Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once you’ve had chickenpox, the virus remains in your body for your entire life, but is dormant or silent for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people (20%) who get shingles develop PHN.

• #4 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. […] Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. […] The frequency and severity of PHN increase with advancing age, occurring in 20% of people aged 60-65 years who have had acute HZ, and in more than 30% of people aged 80 years. […] In addition to age, risk factors for developing PHN after HZ include the presence of a prodrome (defined as pain and/or abnormal sensations before rash onset), severe rash (defined as 50 lesions: papules, vesicles, or crusted vesicles), and severe pain during the acute phase.

• #5 Acute Herpes Zoster and Postherpetic Neuralgia | PM&R KnowledgeNow

  https://now.aapmr.org/acute-herpes-zoster-and-post-herpetic-neuralgia/

  Initial infection by VZV causes varicella, also known as chicken pox. After resolution of the initial infection, the virus remains dormant in the dorsal sensory ganglia or cranial nerve ganglia of the nervous system. As immunity declines with age, VZV can reactivate, resulting in an acute HZ flare, due to reactivation of the virus. […] The incidence of developing PHN is 10-25%, and increases with age, more severe rash and acute HZ pain, ophthalmic involvement, and presence of prodromal symptoms (pain, dysesthesia, and allodynia). Other risk factors include immunosuppression, diabetes, sensory abnormalities in the affected dermatomes, polyneuropathy, and trauma. […] The reactivation of VZV in the sensory ganglia causes inflammation and neuronal destruction. […] Pain severity and location, as well as the patients behavioral response to pain, can interfere with quality of life and functional status/independence.

• #6 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 VZV is a double-stranded DNA virus. It lays dormant in the ganglia of certain peripheral and central nerves after an episode of varicella resolves, generally in youth, with the immune system of the host eradicating the virus in most locations within the body. Advancing age combined with a decrease in immunocompetence, usually accompanied by a psychological or physical stressor, may result in reactivation of the dormant/latent VZV as HZ. […] Well-established risk factors for an acute HZ episode progressing to PHN include age, severe immunosuppression, the presence of a prodromal phase, severe pain during zoster outbreak, allodynia, ophthalmic involvement, and diabetes mellitus.

• #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 VZV is a double-stranded DNA virus. It lays dormant in the ganglia of certain peripheral and central nerves after an episode of varicella resolves, generally in youth, with the immune system of the host eradicating the virus in most locations within the body. Advancing age combined with a decrease in immunocompetence, usually accompanied by a psychological or physical stressor, may result in reactivation of the dormant/latent VZV as HZ. […] Well-established risk factors for an acute HZ episode progressing to PHN include age, severe immunosuppression, the presence of a prodromal phase, severe pain during zoster outbreak, allodynia, ophthalmic involvement, and diabetes mellitus.

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

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

  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. […] Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once you’ve had chickenpox, the virus remains in your body for your entire life, but is dormant or silent for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people (20%) who get shingles develop PHN.

• #9 Acute Herpes Zoster and Postherpetic Neuralgia | PM&R KnowledgeNow

  https://now.aapmr.org/acute-herpes-zoster-and-post-herpetic-neuralgia/

  Initial infection by VZV causes varicella, also known as chicken pox. After resolution of the initial infection, the virus remains dormant in the dorsal sensory ganglia or cranial nerve ganglia of the nervous system. As immunity declines with age, VZV can reactivate, resulting in an acute HZ flare, due to reactivation of the virus. […] The incidence of developing PHN is 10-25%, and increases with age, more severe rash and acute HZ pain, ophthalmic involvement, and presence of prodromal symptoms (pain, dysesthesia, and allodynia). Other risk factors include immunosuppression, diabetes, sensory abnormalities in the affected dermatomes, polyneuropathy, and trauma. […] The reactivation of VZV in the sensory ganglia causes inflammation and neuronal destruction. […] Pain severity and location, as well as the patients behavioral response to pain, can interfere with quality of life and functional status/independence.

• #10 Postherpetic Neuralgia – Sound Pain Alliance Causes & Treatments

  https://www.soundpainalliance.com/conditions/shingle-pain/postherpetic-neuralgia/

  Postherpetic neuralgia is the most common complication of shingles. The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. […] Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers can’t send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that can last months or even years. […] When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of: Age. You’re older than 50. Severity of shingles. You had a severe rash and severe pain. Other illness. You have a chronic disease, such as diabetes. Shingles location. You had shingles on your face or torso. Delayed treatment. Your shingles antiviral treatment was delayed for more than 72 hours after your rash appeared.

• #11 Postherpetic Neuralgia – Shingles | Clearway Pain Solutions

  https://clearwaypain.com/condition/postherpetic-neuralgia-shingles/

  Postherpetic neuralgia is a form of neuropathic pain, which can last for months or years, even after the virus is no longer active. […] The source of chickenpox, shingles, and postherpetic neuralgia are all from a single virus called varicella zoster virus (VZV). […] However, in about one-third of people, the infection does come back in the form of shingles. Postherpetic neuralgia then typically occurs in the area where the shingles occurred. […] Some people are at a higher risk for shingles and postherpetic neuralgia than others, but when used correctly, the available treatments can prevent postherpetic neuralgia or at least stop it from becoming a permanent, painful condition.

• #12

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion. […] This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity. […] The traditional explanation of pain in HZ and PHN is cutaneous inflammation in the herpetic rash, and deafferentation due to necrosis of the infected DRG.

• #13

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #14

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion. […] This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity. […] The traditional explanation of pain in HZ and PHN is cutaneous inflammation in the herpetic rash, and deafferentation due to necrosis of the infected DRG.

• #15 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. […] Shingles is caused by the chickenpox (varicella-zoster) virus. […] The pain is caused by the nerve endings which were affected by the shingles. These are inflamed or damaged by the infection. […] The symptoms of postherpetic neuralgia can last for several months in some people. Shingles causes inflammation of the nerve. […] It is thought that some scar tissue or ongoing inflammation next to the nerve, or in the nearby part of the spinal cord, may be a factor. This may cause pain messages to be sent to the brain.

• #16

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  The 2 processes currently believed to cause pain in HZ and PHN are virally induced inflammation, which sensitizes nociceptors in the infected skin, and deafferentation due to destruction of sensory neurons in a single virally infected DRG. […] The idea that HZ/PHN results from VZV reactivation in a single DRG is based on 2 related observations: the unilateral dermatomal distribution of symptoms and pathological observations of inflammation and loss of nerve fibers and sensory cell somata in DRGs. […] The striking inconsistencies with inflammation being a prime cause of pain, in PHN in particular, call out for an alternative explanation. […] The ectopic pacemaker hypothesis of pain in HZ and PHN attempts to interpret the clinical facts surrounding HZ/PHN in light of recent advances in our understanding on the biology of neuropathic pain.

• #17 FF #272 Postherpetic Neuralgia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/

  For those who develop PHN, prolonged severe disabling symptoms rarely remain beyond 6 months. […] A small subset may experience irreversible damage to skin and sensory abnormalities that can result in ongoing pain for years. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds. […] Initiating antiviral drugs within 72 hours of rash onset reduces acute and chronic pain associated with HZ. […] Best available evidence does not support the routine use of glucocorticoids in preventing PHN. […] PHN is a quintessential neuropathic pain syndrome, and the analgesic approach is like other neuropathic syndromes. […] Strong evidence also supports combined therapy of gabapentin plus opioids or TCAs.

• #18 Post-herpetic neuralgia

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

  Post-herpetic neuralgia is usually a chronic neuropathic pain with a burning character, but some patients experience sharp stabbing pains. […] Acute herpes zoster pain is due to direct damage of peripheral nerves by the herpes zoster virus. Ongoing post-herpetic neuralgia is due to slow recovery and the involvement of the central nervous system. […] Research has shown that the nerves or neurones affected by post-herpetic neuralgia are damaged. Microscopic changes include: Atrophy and deafferentation (loss of connections) of dorsal horns of affected dermatomes, Pathological changes in spinal cord sensory ganglions (nerve cell bodies), Markedly reduced number and density of sensory nerves in affected skin. […] It has been suggested that these damaged nerves send fewer signals from the skin to central nervous structures, which leads to neuron hyperexcitability and the constant perception of pain. However, the exact pathways are unknown. […] It is likely that acute and sub-acute pain, and sensory changes such as allodynia, arise from slightly different mechanisms.

• #19

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #20 Postherpetic neuralgia: Treatment, symptoms, and causes

  https://www.medicalnewstoday.com/articles/160253

  Postherpetic neuralgia is a painful condition that affects the nerve fibers and skin. It is a complication of shingles, and shingles is a complication of chicken pox. […] If the pain caused by shingles continues after the bout of shingles is over, it is known as post-herpetic neuralgia (PHN). It is estimated that about 1 in 5 patients with shingles will go on to have PHN. […] PHN is a persistent nerve pain that can occur as a result of shingles. Shingles is caused by the herpes varicella-zoster virus, the virus known to cause chickenpox. After a person recovers from chickenpox, the virus remains inactive in the nervous system. […] The nerve damage that is caused by shingles disrupts the proper functioning of the nerve. The faulty nerve becomes confused and sends random, chaotic pain signals to the brain. This can lead to a throbbing, burning pain along the nerve. […] Experts believe that shingles causes scar tissue to form next to the nerves, creating pressure. This causes the nerves to send inaccurate signals, many of them pain signals, to the brain. It is unclear why some patients go on to develop PHN.

• #21 Postherpetic Neuralgia | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p690.html

  Pain that occurs after resolution of acute herpes zoster infection can be severe. […] The main risk factor for postherpetic neuralgia is increasing age. The condition is uncommon in persons younger than 50 years. However, among persons who have had acute herpes zoster, it develops in 20 percent of those 60 to 65 years of age and in greater than 30 percent of those older than 80 years. […] Postherpetic neuralgia is thought to arise following nerve damage caused by herpes zoster. […] The main risk factor for postherpetic neuralgia is increasing age. In the U.K. general practice study there was little risk in those younger than 50 years, but postherpetic neuralgia developed in greater than 20 percent of persons 60 to 65 years of age who had had acute herpes zoster, and in 34 percent of those older than 80 years. […] Other risk factors for postherpetic neuralgia are severe pain with herpes zoster, greater rash severity, increased neurologic abnormalities in the affected dermatome (sensory loss), the presence of a prodrome, a more pronounced immune response, and psychosocial factors.

• #22 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. […] Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. […] The frequency and severity of PHN increase with advancing age, occurring in 20% of people aged 60-65 years who have had acute HZ, and in more than 30% of people aged 80 years. […] In addition to age, risk factors for developing PHN after HZ include the presence of a prodrome (defined as pain and/or abnormal sensations before rash onset), severe rash (defined as 50 lesions: papules, vesicles, or crusted vesicles), and severe pain during the acute phase.

• #23 FF #272 Postherpetic Neuralgia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/

  Postherpetic neuralgia (PHN) is a syndrome of zoster-associated pain persisting more than 3 months after resolution of an initial herpes zoster (HZ) rash (‘shingles’). […] PHN develops rarely in those under 50 years. However, it occurs in 20% of persons 60 to 65 with HZ and its incidence rises to 30% in persons over 80 years old. […] Risk factors for PHN include severe acute shingles-related pain, rash severity (i.e., more than 50 lesions), increasing age, and immunocompromised status. […] In acute HZ, reactivation of the virus from the dorsal root ganglia of spinal or cranial nerves causes inflammation and damage to the affected nerve tissue, resulting in acute pain. […] This central sensitization is thought to be a key mechanism in the development and maintenance of the pain of PHN.

• #24 Postherpetic Neuralgia | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0915/p690.html

  Pain that occurs after resolution of acute herpes zoster infection can be severe. […] The main risk factor for postherpetic neuralgia is increasing age. The condition is uncommon in persons younger than 50 years. However, among persons who have had acute herpes zoster, it develops in 20 percent of those 60 to 65 years of age and in greater than 30 percent of those older than 80 years. […] Postherpetic neuralgia is thought to arise following nerve damage caused by herpes zoster. […] The main risk factor for postherpetic neuralgia is increasing age. In the U.K. general practice study there was little risk in those younger than 50 years, but postherpetic neuralgia developed in greater than 20 percent of persons 60 to 65 years of age who had had acute herpes zoster, and in 34 percent of those older than 80 years. […] Other risk factors for postherpetic neuralgia are severe pain with herpes zoster, greater rash severity, increased neurologic abnormalities in the affected dermatome (sensory loss), the presence of a prodrome, a more pronounced immune response, and psychosocial factors.

• #25 Postherpetic neuralgia – Wikipedia

  https://en.wikipedia.org/wiki/Postherpetic_neuralgia

  Since herpes zoster occurs due to reactivation of the varicella zoster virus, which is more likely to occur with a weakened immune system, both herpes zoster and PHN occur more often in the elderly. […] The incidence of herpes zoster, and also developing postherpetic neuralgia, both increase with age. The frequency and severity of postherpetic neuralgia increase with advancing age, occurring in 20% of people age 60-65 years old who have had herpes zoster, and in more than 30% of people over 80 years old.

• #26 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. […] Postherpetic neuralgia is the most common shingles complication. It occurs when a shingles outbreak damages the nerves. […] According to a 2017 review, about 20% of people who get shingles also develop postherpetic neuralgia. People who are older when they get shingles are more likely to get postherpetic neuralgia. […] Age is a major risk factor for getting both shingles and postherpetic neuralgia. Risk begins to increase at age 50 and rises the older you get. […] Some research suggests that postherpetic neuralgia affects 60% of those 60 or older and 75% of those 70 or older. […] People who have severe pain and rash during shingles also have a higher risk of developing postherpetic neuralgia.

• #27 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 VZV is a double-stranded DNA virus. It lays dormant in the ganglia of certain peripheral and central nerves after an episode of varicella resolves, generally in youth, with the immune system of the host eradicating the virus in most locations within the body. Advancing age combined with a decrease in immunocompetence, usually accompanied by a psychological or physical stressor, may result in reactivation of the dormant/latent VZV as HZ. […] Well-established risk factors for an acute HZ episode progressing to PHN include age, severe immunosuppression, the presence of a prodromal phase, severe pain during zoster outbreak, allodynia, ophthalmic involvement, and diabetes mellitus.

• #28

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. […] By preventing zoster through vaccination, the risk of this common complication is reduced. […] Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). […] Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. […] A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4).

• #29

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. […] By preventing zoster through vaccination, the risk of this common complication is reduced. […] Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). […] Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. […] A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4).

• #30 Postherpetic Neuralgia: Background, Pathophysiology, Etiology

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

  Risk factors for the development of PHN include the following: Advancing age, Specific sites of HZ involvement – Highest risk: trigeminal (especially ophthalmic division), brachial plexus; moderate risk: thoracic; lower risk: jaw, neck, sacral, lumbar, Severe prodromal pain (with HZ), Severe rash. […] Family history has been described as a risk factor for HZ. In a case-control study of 504 patients and 523 controls, Hicks et al found that HZ patients were more likely to report blood relatives with HZ than control subjects were (39% vs 11%). This risk was higher in patients who had multiple blood relatives with HZ than in those who had only one blood relative with HZ.

• #31

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. […] By preventing zoster through vaccination, the risk of this common complication is reduced. […] Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). […] Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. […] A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4).

• #32

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. […] By preventing zoster through vaccination, the risk of this common complication is reduced. […] Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). […] Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. […] A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4).

• #33 Postherpetic Neuralgia: Background, Pathophysiology, Etiology

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

  Risk factors for the development of PHN include the following: Advancing age, Specific sites of HZ involvement – Highest risk: trigeminal (especially ophthalmic division), brachial plexus; moderate risk: thoracic; lower risk: jaw, neck, sacral, lumbar, Severe prodromal pain (with HZ), Severe rash. […] Family history has been described as a risk factor for HZ. In a case-control study of 504 patients and 523 controls, Hicks et al found that HZ patients were more likely to report blood relatives with HZ than control subjects were (39% vs 11%). This risk was higher in patients who had multiple blood relatives with HZ than in those who had only one blood relative with HZ.

• #34 Postherpetic neuralgia – Wikipedia

  https://en.wikipedia.org/wiki/Postherpetic_neuralgia

  Postherpetic neuralgia (PHN) is neuropathic pain that occurs due to damage to a peripheral nerve caused by the reactivation of the varicella zoster virus (herpes zoster, also known as shingles). PHN is defined as pain in a dermatomal distribution that lasts for at least 90 days after an outbreak of herpes zoster. […] Postherpetic neuralgia is the most common long-term complication of herpes zoster, and occurs in approximately 20% of patients with shingles. Risk factors for PHN include older age, severe prodrome or rash, severe acute zoster pain, ophthalmic involvement, immunosuppression, and chronic conditions such as diabetes mellitus and lupus. […] The nerve pain of PHN is thought to result from damage in a peripheral nerve that was affected by the reactivation of the varicella zoster virus.

• #35

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. […] By preventing zoster through vaccination, the risk of this common complication is reduced. […] Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). […] Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. […] A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4).

• #36 Postherpetic Neuralgia

  https://www.uspharmacist.com/article/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a painful nerve condition that lingers after a shingles (herpes zoster) infection. […] Chronic nerve pain occurs in about 20% of patients who develop shingles in their 60s, and it is even more likely in 70- and 80-year-old patients with shingles. […] Postherpetic neuralgia pain can continue for months or years as a result of nerve damage caused by the shingles virus. […] The virus that causes chickenpox, varicella zoster, quietly remains inactive in the nervous system after a person recovers from chickenpox. […] In certain patients, the varicella zoster virus becomes active again in later life (usually after age 60 years), causing the pain, rash, and blisters of shingles. […] Common causes of weakened immunity include emotional or physical stress, traumatic injuries, cancer, autoimmune disease, HIV/AIDS, and treatments such as chemotherapy, steroids, and radiation therapy.

• #37

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Systemic lupus erythematosus, recent trauma, and personality disorder symptoms were associated with postherpetic neuralgia in single studies. […] Our review confirms a number of clinical features of acute zoster are risk factors for postherpetic neuralgia. […] It has also identified a range of possible vaccine-targetable risk factors for postherpetic neuralgia; yet aside from age-associated risks, evidence regarding risk factors to inform zoster vaccination policy is currently limited. […] The pain has been described as a constant burning or stabbing sensation, and some individuals experience allodynia (pain triggered from light contact with nonpainful stimuli). […] PHN is the most common complication of zoster; an estimated 12.5% of patients with zoster aged 50 years have PHN 3 months after zoster onset, and the proportion affected increases sharply with age.

• #38

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Systemic lupus erythematosus, recent trauma, and personality disorder symptoms were associated with postherpetic neuralgia in single studies. […] Our review confirms a number of clinical features of acute zoster are risk factors for postherpetic neuralgia. […] It has also identified a range of possible vaccine-targetable risk factors for postherpetic neuralgia; yet aside from age-associated risks, evidence regarding risk factors to inform zoster vaccination policy is currently limited. […] The pain has been described as a constant burning or stabbing sensation, and some individuals experience allodynia (pain triggered from light contact with nonpainful stimuli). […] PHN is the most common complication of zoster; an estimated 12.5% of patients with zoster aged 50 years have PHN 3 months after zoster onset, and the proportion affected increases sharply with age.

• #39 Postherpetic Neuralgia – Sound Pain Alliance Causes & Treatments

  https://www.soundpainalliance.com/conditions/shingle-pain/postherpetic-neuralgia/

  Postherpetic neuralgia is the most common complication of shingles. The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. […] Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers can’t send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that can last months or even years. […] When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of: Age. You’re older than 50. Severity of shingles. You had a severe rash and severe pain. Other illness. You have a chronic disease, such as diabetes. Shingles location. You had shingles on your face or torso. Delayed treatment. Your shingles antiviral treatment was delayed for more than 72 hours after your rash appeared.

• #40 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

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

  A meta-analysis of the risk factors for the development of PHN published in 2016 noted that approximately 13% of patients older than or equal to 50 years of age with HZ would develop PHN. […] The incidence increases with advancing age, which underscores the importance of immunocompetence, as a decrease in cell-mediated immunity is likely already present in those with HZ. […] The association between increasing age and PHN is significant. […] Family history has also been considered a risk factor for herpes zoster. […] There is no sex predilection for postherpetic neuralgia.

• #41 Postherpetic Neuralgia: Background, Pathophysiology, Etiology

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

  Risk factors for the development of PHN include the following: Advancing age, Specific sites of HZ involvement – Highest risk: trigeminal (especially ophthalmic division), brachial plexus; moderate risk: thoracic; lower risk: jaw, neck, sacral, lumbar, Severe prodromal pain (with HZ), Severe rash. […] Family history has been described as a risk factor for HZ. In a case-control study of 504 patients and 523 controls, Hicks et al found that HZ patients were more likely to report blood relatives with HZ than control subjects were (39% vs 11%). This risk was higher in patients who had multiple blood relatives with HZ than in those who had only one blood relative with HZ.

• #42

  https://www.aurorahealthcare.org/services/neuroscience/neurology/neurological-conditions/neuromuscular-disorders/postherpetic-neuralgia

  If you’ve experienced a shingles (herpes zoster) infection, you might encounter postherpetic neuralgia (PHN). About one in five people whove had shingles may develop postherpetic neuralgia. […] Shingles is caused by the varicella-zoster virus (VZV), which also causes chickenpox. After a person recovers from chickenpox, the virus lies dormant in their nervous system. Decades later, the virus can reactivate and trigger the painful rash and blisters that are symptoms of shingles. […] Postherpetic neuralgia is a complication of shingles that causes severe pain in the areas that were affected by shingles. Shingles damages nerves in the areas it affects, scrambling signals to the brain and leading to postherpetic neuralgia. […] Factors such as older age, diabetes and having a compromised immune system increase the risk of developing PHN. You may be more at risk for PHN if a blood relative has had it.

• #43 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

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

  A meta-analysis of the risk factors for the development of PHN published in 2016 noted that approximately 13% of patients older than or equal to 50 years of age with HZ would develop PHN. […] The incidence increases with advancing age, which underscores the importance of immunocompetence, as a decrease in cell-mediated immunity is likely already present in those with HZ. […] The association between increasing age and PHN is significant. […] Family history has also been considered a risk factor for herpes zoster. […] There is no sex predilection for postherpetic neuralgia.

• #44 Postherpetic Neuralgia: Nerve Pain After Shingles

  https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-postherpetic-neuralgia-treatment

  Most people who get postherpetic neuralgia are older than 60. […] Women seem to get it more than men. […] People who have numbness, tingling, or itching before a shingles rash even appears tend to get the lingering pain later. […] If you had severe pain or a rash during the beginning of your outbreak, you have a greater chance of the neuralgia later. […] People with ongoing conditions that can weaken the immune system, like HIV and cancer, seem more likely to get it.

• #45

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #46 Postherpetic neuralgia | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a painful condition that can arise after a shingles outbreak, which is caused by the reactivation of the varicella-zoster virus. […] The underlying mechanisms of PHN involve nerve damage and inflammation caused by the viral infection. […] A subset of persons subsequently develops PHN and continues to feel pain long after. The proposed pathogenetic mechanisms underlying this phenomenon stem from the intense inflammation associated with this viral infection and include degeneration of neuronal axon and cell body, atrophy of the spinal cord dorsal horn, scarring of dorsal root ganglia, and loss of skin nerve supply in the affected region. […] No treatment appears to prevent PHN completely, but some approaches may shorten the duration or lessen the severity of symptoms. Aggressive, early treatment of shingles reduces the likelihood of complications. Studies have shown that the administration of antiviral drugs (especially valaciclovir and famciclovir) attenuates the severity of the infection and the neural damage it causes, thereby reducing the incidence and duration of PHN.

• #47

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  Pro-inflammatory cytokines IL-1 and TNF- play a pivotal role by sensitizing nociceptors, influencing pain signaling. […] While VZV infection has conventionally been associated with peripheral effects, the presence of acute or persistent inflammation and nerve damage can lead to enduring modifications in central nervous system (CNS) pain pathways. […] The cascading effects of VZV reactivation on the nervous system create the complex landscape of TG-PHN.

• #48

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #49

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #50

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #51

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  Pro-inflammatory cytokines IL-1 and TNF- play a pivotal role by sensitizing nociceptors, influencing pain signaling. […] While VZV infection has conventionally been associated with peripheral effects, the presence of acute or persistent inflammation and nerve damage can lead to enduring modifications in central nervous system (CNS) pain pathways. […] The cascading effects of VZV reactivation on the nervous system create the complex landscape of TG-PHN.

• #52 FF #272 Postherpetic Neuralgia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/

  For those who develop PHN, prolonged severe disabling symptoms rarely remain beyond 6 months. […] A small subset may experience irreversible damage to skin and sensory abnormalities that can result in ongoing pain for years. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds. […] Initiating antiviral drugs within 72 hours of rash onset reduces acute and chronic pain associated with HZ. […] Best available evidence does not support the routine use of glucocorticoids in preventing PHN. […] PHN is a quintessential neuropathic pain syndrome, and the analgesic approach is like other neuropathic syndromes. […] Strong evidence also supports combined therapy of gabapentin plus opioids or TCAs.

• #53

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #54 Post-herpetic neuralgia

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

  Post-herpetic neuralgia is usually a chronic neuropathic pain with a burning character, but some patients experience sharp stabbing pains. […] Acute herpes zoster pain is due to direct damage of peripheral nerves by the herpes zoster virus. Ongoing post-herpetic neuralgia is due to slow recovery and the involvement of the central nervous system. […] Research has shown that the nerves or neurones affected by post-herpetic neuralgia are damaged. Microscopic changes include: Atrophy and deafferentation (loss of connections) of dorsal horns of affected dermatomes, Pathological changes in spinal cord sensory ganglions (nerve cell bodies), Markedly reduced number and density of sensory nerves in affected skin. […] It has been suggested that these damaged nerves send fewer signals from the skin to central nervous structures, which leads to neuron hyperexcitability and the constant perception of pain. However, the exact pathways are unknown. […] It is likely that acute and sub-acute pain, and sensory changes such as allodynia, arise from slightly different mechanisms.

• #55

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion. […] This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity. […] The traditional explanation of pain in HZ and PHN is cutaneous inflammation in the herpetic rash, and deafferentation due to necrosis of the infected DRG.

• #56

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion. […] This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity. […] The traditional explanation of pain in HZ and PHN is cutaneous inflammation in the herpetic rash, and deafferentation due to necrosis of the infected DRG.

• #57

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  The 2 processes currently believed to cause pain in HZ and PHN are virally induced inflammation, which sensitizes nociceptors in the infected skin, and deafferentation due to destruction of sensory neurons in a single virally infected DRG. […] The idea that HZ/PHN results from VZV reactivation in a single DRG is based on 2 related observations: the unilateral dermatomal distribution of symptoms and pathological observations of inflammation and loss of nerve fibers and sensory cell somata in DRGs. […] The striking inconsistencies with inflammation being a prime cause of pain, in PHN in particular, call out for an alternative explanation. […] The ectopic pacemaker hypothesis of pain in HZ and PHN attempts to interpret the clinical facts surrounding HZ/PHN in light of recent advances in our understanding on the biology of neuropathic pain.

• #58

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  Pain in herpes zoster (HZ) and postherpetic neuralgia (PHN) is traditionally explained in terms of 2 processes: irritable nociceptors in the rash-inflamed skin and, later, deafferentation due to destruction of sensory neurons in one virally infected dorsal root ganglion. […] This model, the ectopic pacemaker hypothesis of HZ and PHN, proposes that pain in both conditions is driven by hyperexcitable ectopic pacemaker sites at various locations in primary sensory neurons affected by the causative varicella zoster virus infection. This peripheral input is exacerbated by central sensitization induced and maintained by the ectopic activity. […] The traditional explanation of pain in HZ and PHN is cutaneous inflammation in the herpetic rash, and deafferentation due to necrosis of the infected DRG.

• #59

  https://journals.lww.com/painrpts/fulltext/2018/12000/rethinking_the_causes_of_pain_in_herpes_zoster_and.1.aspx

  The ectopic pacemaker hypothesis posits that, in HZ patients who do not go on to develop PHN, inflammation is the principal factor that exacerbates ectopic discharge. […] The ectopic pacemaker hypothesis stresses 3 principles: (1) diagnostic identification, in the individual patient, of where the pain-provoking impulses are coming from, (2) targeting the primary source(s), and (3) focusing on suppression of ectopic electrogenesis using nonblocking concentrations of membrane-stabilizing drugs.

• #60 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #61 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #62 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #63 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #64 Postherpetic Neuralgia – Precision Spine Care – Neurological Pain in Texas

  https://precisionspinecare.com/conditions/postherpetic-neuralgia/

  Postherpetic neuralgia is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. […] The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. Theres no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time. […] The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred most commonly in a band around your trunk, usually on one side of your body. […] Pain that lasts three months or longer after the shingles rash has healed. The associated pain has been described as burning, sharp and jabbing, or deep and aching. […] Sensitivity to light touch: People with the condition often cant bear even the touch of clothing on the affected skin (allodynia). […] Itching and numbness: Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.

• #65 Postherpetic Neuralgia – Precision Spine Care – Neurological Pain in Texas

  https://precisionspinecare.com/conditions/postherpetic-neuralgia/

  Postherpetic neuralgia is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. […] The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. Theres no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time. […] The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred most commonly in a band around your trunk, usually on one side of your body. […] Pain that lasts three months or longer after the shingles rash has healed. The associated pain has been described as burning, sharp and jabbing, or deep and aching. […] Sensitivity to light touch: People with the condition often cant bear even the touch of clothing on the affected skin (allodynia). […] Itching and numbness: Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.

• #66

  https://www.advocatehealth.com/health-services/brain-spine-institute/brain-care-center/conditions-treatments/neuromuscular-disorders/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is sometimes triggered after youve had a shingles (herpes zoster) infection. About one in five people whove had shingles will get postherpetic neuralgia. […] Postherpetic neuralgia is a complication of shingles that causes pain in the areas that have been affected by shingles. Shingles damages nerves in the area, which causes the pain from PHN. […] Some of the risk factors for PHN are older age, having diabetes and having a compromised immune system. If you have a blood relative whos had postherpetic neuralgia, you may be more at risk for it. […] The pain from postherpetic neuralgia can last for months, years or even become chronic. […] Postherpetic neuralgia is resistant to treatment. […] The best way to avoid postherpetic neuralgia is by getting the appropriate vaccinations. […] Getting prompt treatment for a shingles infection can also help prevent a bad case of postherpetic neuralgia.

• #67 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #68

  https://www.aurorahealthcare.org/services/neuroscience/neurology/neurological-conditions/neuromuscular-disorders/postherpetic-neuralgia

  Postherpetic neuralgia is notoriously resistant to treatment. Your doctor may use a combination of treatments to manage symptoms effectively. […] Appropriate vaccinations are key to avoiding PHN. Young children should receive a two-dose chickenpox vaccine. The two-dose shingles vaccine is recommended for adults older than 50. Preventing these infections prevents you from getting postherpetic neuralgia. […] Prompt treatment with antiviral medications within two to three days of shingles symptoms can also help prevent a severe case of postherpetic neuralgia.

• #69

  https://www.aurorahealthcare.org/services/neuroscience/neurology/neurological-conditions/neuromuscular-disorders/postherpetic-neuralgia

  Postherpetic neuralgia is notoriously resistant to treatment. Your doctor may use a combination of treatments to manage symptoms effectively. […] Appropriate vaccinations are key to avoiding PHN. Young children should receive a two-dose chickenpox vaccine. The two-dose shingles vaccine is recommended for adults older than 50. Preventing these infections prevents you from getting postherpetic neuralgia. […] Prompt treatment with antiviral medications within two to three days of shingles symptoms can also help prevent a severe case of postherpetic neuralgia.

• #70

  https://www.aurorahealthcare.org/services/neuroscience/neurology/neurological-conditions/neuromuscular-disorders/postherpetic-neuralgia

  Postherpetic neuralgia is notoriously resistant to treatment. Your doctor may use a combination of treatments to manage symptoms effectively. […] Appropriate vaccinations are key to avoiding PHN. Young children should receive a two-dose chickenpox vaccine. The two-dose shingles vaccine is recommended for adults older than 50. Preventing these infections prevents you from getting postherpetic neuralgia. […] Prompt treatment with antiviral medications within two to three days of shingles symptoms can also help prevent a severe case of postherpetic neuralgia.

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

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

  Doctors typically try to prevent postherpetic neuralgia in people with shingles by treating severe cases. Early treatment may prevent postherpetic neuralgia. […] Two doses of a herpes zoster vaccine called Shingrix reduce the risk of shingles by more than 90%. The vaccine also protects against postherpetic neuralgia.

• #72 FF #272 Postherpetic Neuralgia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/

  For those who develop PHN, prolonged severe disabling symptoms rarely remain beyond 6 months. […] A small subset may experience irreversible damage to skin and sensory abnormalities that can result in ongoing pain for years. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds. […] Initiating antiviral drugs within 72 hours of rash onset reduces acute and chronic pain associated with HZ. […] Best available evidence does not support the routine use of glucocorticoids in preventing PHN. […] PHN is a quintessential neuropathic pain syndrome, and the analgesic approach is like other neuropathic syndromes. […] Strong evidence also supports combined therapy of gabapentin plus opioids or TCAs.

• #73 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #74 Postherpetic Neuralgia Treatment NYC | Pain Management NYC

  https://www.painmanagementnyc.com/nerve-pain/postherpetic-neuralgia/

  Compromised immune system. Anything that compromises your immune system such as cancer treatment affects your bodys ability to fight off disease and increases your risk of developing other illnesses such as PHN. […] Vaccination offers protection against shingles and complications related to shingles. […] If you develop a shingles rash, taking antiviral medication within 72 hours after the rash appears aids in preventing complications. […] The shingles vaccine can prevent both shingles and complications of shingles such as PHN. […] Shingrix is considered 90 percent effective in protecting against shingles and postherpetic neuralgia.

• #75

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Postherpetic neuralgia is often refractory to treatment. […] Despite decades of research, evidence for the efficacy of administering antivirals at first appearance of the rash in reducing PHN incidence is unconvincing. […] However, an effective live-attenuated vaccine is now available providing protection against zoster and might be used to protect those most likely to develop PHN and other complications of zoster. […] Apart from age, other often reported risk factors for PHN relate largely to characteristics of the acute zoster episode, particularly, the severity of acute pain and rash at initial zoster presentation; however, the evidence has not been systematically reviewed. […] This article aims to systematically collate and summarise the epidemiological literature on risk factors for PHN including clinical features of acute zoster and those which are vaccine-targetable.

• #76 Postherpetic neuralgia | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a painful condition that can arise after a shingles outbreak, which is caused by the reactivation of the varicella-zoster virus. […] The underlying mechanisms of PHN involve nerve damage and inflammation caused by the viral infection. […] A subset of persons subsequently develops PHN and continues to feel pain long after. The proposed pathogenetic mechanisms underlying this phenomenon stem from the intense inflammation associated with this viral infection and include degeneration of neuronal axon and cell body, atrophy of the spinal cord dorsal horn, scarring of dorsal root ganglia, and loss of skin nerve supply in the affected region. […] No treatment appears to prevent PHN completely, but some approaches may shorten the duration or lessen the severity of symptoms. Aggressive, early treatment of shingles reduces the likelihood of complications. Studies have shown that the administration of antiviral drugs (especially valaciclovir and famciclovir) attenuates the severity of the infection and the neural damage it causes, thereby reducing the incidence and duration of PHN.

• #77 Postherpetic neuralgia | EBSCO Research Starters

  https://www.ebsco.com/research-starters/health-and-medicine/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a painful condition that can arise after a shingles outbreak, which is caused by the reactivation of the varicella-zoster virus. […] The underlying mechanisms of PHN involve nerve damage and inflammation caused by the viral infection. […] A subset of persons subsequently develops PHN and continues to feel pain long after. The proposed pathogenetic mechanisms underlying this phenomenon stem from the intense inflammation associated with this viral infection and include degeneration of neuronal axon and cell body, atrophy of the spinal cord dorsal horn, scarring of dorsal root ganglia, and loss of skin nerve supply in the affected region. […] No treatment appears to prevent PHN completely, but some approaches may shorten the duration or lessen the severity of symptoms. Aggressive, early treatment of shingles reduces the likelihood of complications. Studies have shown that the administration of antiviral drugs (especially valaciclovir and famciclovir) attenuates the severity of the infection and the neural damage it causes, thereby reducing the incidence and duration of PHN.

• #78 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. […] Postherpetic neuralgia is the most common shingles complication. It occurs when a shingles outbreak damages the nerves. […] According to a 2017 review, about 20% of people who get shingles also develop postherpetic neuralgia. People who are older when they get shingles are more likely to get postherpetic neuralgia. […] Age is a major risk factor for getting both shingles and postherpetic neuralgia. Risk begins to increase at age 50 and rises the older you get. […] Some research suggests that postherpetic neuralgia affects 60% of those 60 or older and 75% of those 70 or older. […] People who have severe pain and rash during shingles also have a higher risk of developing postherpetic neuralgia.

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

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

  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. […] Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once you’ve had chickenpox, the virus remains in your body for your entire life, but is dormant or silent for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people (20%) who get shingles develop PHN.

• #80

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  VZV DNA was detected in the peripheral blood mononuclear cells months to years after the resolution of the zoster rash in patients with PHN, potentially reflecting a higher viral burden in the ganglia than during actual latency. […] TG-PHN, caused by the VZV reactivation, involves intricate changes in pain signaling pathways, leading to heightened pain response through nociceptors sensitization, sensitivity due to local inflammatory mediators, augmented pain pathways excitability, and diminished inhibitory control. […] VZV replication can induce acute injury to sensory neurons, exacerbating inflammatory tissue damage. […] The presence of viral proteins coupled with immune responses initiates inflammation at the affected site and contributes to pain and heightened sensitivity. […] The intricate interplay between heightened inflammation and neuronal activity underscores the complexities of pain modulation.

• #81 Post-herpetic neuralgia

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

  Post-herpetic neuralgia is usually a chronic neuropathic pain with a burning character, but some patients experience sharp stabbing pains. […] Acute herpes zoster pain is due to direct damage of peripheral nerves by the herpes zoster virus. Ongoing post-herpetic neuralgia is due to slow recovery and the involvement of the central nervous system. […] Research has shown that the nerves or neurones affected by post-herpetic neuralgia are damaged. Microscopic changes include: Atrophy and deafferentation (loss of connections) of dorsal horns of affected dermatomes, Pathological changes in spinal cord sensory ganglions (nerve cell bodies), Markedly reduced number and density of sensory nerves in affected skin. […] It has been suggested that these damaged nerves send fewer signals from the skin to central nervous structures, which leads to neuron hyperexcitability and the constant perception of pain. However, the exact pathways are unknown. […] It is likely that acute and sub-acute pain, and sensory changes such as allodynia, arise from slightly different mechanisms.

• #82 Postherpetic Neuralgia – Sound Pain Alliance Causes & Treatments

  https://www.soundpainalliance.com/conditions/shingle-pain/postherpetic-neuralgia/

  Postherpetic neuralgia is the most common complication of shingles. The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. […] Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers can’t send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that can last months or even years. […] When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of: Age. You’re older than 50. Severity of shingles. You had a severe rash and severe pain. Other illness. You have a chronic disease, such as diabetes. Shingles location. You had shingles on your face or torso. Delayed treatment. Your shingles antiviral treatment was delayed for more than 72 hours after your rash appeared.

• #83

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. […] By preventing zoster through vaccination, the risk of this common complication is reduced. […] Meta-analysis showed significant increases in the risk of postherpetic neuralgia with clinical features of acute zoster including prodromal pain (summary rate ratio 2.29, 95% confidence interval: 1.42-3.69), severe acute pain (2.23, 1.71-2.92), severe rash (2.63, 1.89-3.66), and ophthalmic involvement (2.51, 1.29-4.86). […] Older age was significantly associated with postherpetic neuralgia; for individual studies, relative risk estimates per 10-year increase ranged from 1.22 to 3.11. […] A proportion of studies reported an increased risk of postherpetic neuralgia with severe immunosuppression (studies, n = 3/5) and diabetes mellitus (n = 1/4).

• #84 Postherpetic Neuralgia: Background, Pathophysiology, Etiology

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

  Risk factors for the development of PHN include the following: Advancing age, Specific sites of HZ involvement – Highest risk: trigeminal (especially ophthalmic division), brachial plexus; moderate risk: thoracic; lower risk: jaw, neck, sacral, lumbar, Severe prodromal pain (with HZ), Severe rash. […] Family history has been described as a risk factor for HZ. In a case-control study of 504 patients and 523 controls, Hicks et al found that HZ patients were more likely to report blood relatives with HZ than control subjects were (39% vs 11%). This risk was higher in patients who had multiple blood relatives with HZ than in those who had only one blood relative with HZ.

• #85 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/

  PHN occurs in the same dermatomes as the HZ rash, and stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response that accompanied VZV reactivation and migration. […] Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia), enduring for at least 3 months after healing of the HZ-related skin rash. […] The best way to prevent PHN is to avoid infection with VZV. […] Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia.

• #86 Postherpetic Neuralgia Treatment NYC | Pain Management NYC

  https://www.painmanagementnyc.com/nerve-pain/postherpetic-neuralgia/

  Compromised immune system. Anything that compromises your immune system such as cancer treatment affects your bodys ability to fight off disease and increases your risk of developing other illnesses such as PHN. […] Vaccination offers protection against shingles and complications related to shingles. […] If you develop a shingles rash, taking antiviral medication within 72 hours after the rash appears aids in preventing complications. […] The shingles vaccine can prevent both shingles and complications of shingles such as PHN. […] Shingrix is considered 90 percent effective in protecting against shingles and postherpetic neuralgia.

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

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

  Doctors typically try to prevent postherpetic neuralgia in people with shingles by treating severe cases. Early treatment may prevent postherpetic neuralgia. […] Two doses of a herpes zoster vaccine called Shingrix reduce the risk of shingles by more than 90%. The vaccine also protects against postherpetic neuralgia.

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