Pain that lasts even after shingles? Is that postherpetic neuralgia (PHN)? Let's talk about it!

Have you ever had shingles? Or have you ever seen someone you know get it? A snake bite is a very painful experience. But sometimes, even after the snake bite heals, the pain can continue to come back. That's what we're talking about today, Postherpetic Neuralgia (PHN). Don't worry, we'll talk about this simply, in a way that you can understand.

What is postherpetic neuralgia (PHN)? What does it feel like?

Simply put, postherpetic neuralgia (PHN) is a complication of shingles. You may recall that shingles is caused by the reactivation of the same virus that causes chickenpox, the Varicella-zoster virus. It is also called Herpes Zoster.

When a snakebite occurs, a painful, blister-like rash appears on one side of the body, especially on the chest or abdomen. As the rash dries up over time, the pain will subside. However, for some people, the pain at the site of the bite may persist. This is what we call `PHN`, the pain that remains even after the snakebite has healed.

So what does this `PHN` pain feel like?

You will feel pain in the same area where the snakebite occurred. This pain may be constant, or it may come and go. Some people say it feels like a burning sensation, a stabbing sensation, or a sharp pain coming from within . Others (less common) may feel a tingling or itching sensation in the area.

How long can PHN last? Who is more likely to develop it?

PHN pain can last for weeks, months, and even years after a snakebite has healed. For most people, the pain goes away within one to three months. However, it is estimated that about one in five people will have the pain for more than a year.

For some people, the pain from PHN is so severe that it makes it difficult to function in their daily lives. Researchers still don't know exactly why some people have such severe, long-lasting pain while others don't.

How common is this `PHN`?

Varicella-zoster virus is the cause of both chickenpox and shingles. About 99% of Americans over the age of 40 have had chickenpox. In addition, one in three Americans will have a snakebite in their lifetime. Between 10% and 18% of people who get a snakebite will develop PHN. PHN is the most common complication of snakebites.

Who is at higher risk of developing PHN?

The following factors increase the risk of developing PHN:

• Age: The risk of developing PHN increases with age. If you are older and have a snakebite, you are more likely to develop PHN, and the pain will last longer and be more severe than if you were younger. Between 10% and 13% of people over the age of 50 who have a snakebite develop PHN. PHN is very rare in people under the age of 40.
• Weakened immune system: As we age, our body's ability to fight off disease, or our immune system, weakens. Then the dormant varicella-zoster virus can reactivate and cause shingles. The immune system can also be weakened by things like cancer, chronic infections (such as HIV/AIDS), organ transplants, or the use of medications that suppress the immune system (such as chemotherapy, immunosuppressant medicines, steroids, and drugs that prevent organ rejection).
• Severity of snakebite: If you have a severe bite, you are more likely to develop PHN.
• If you had pain, itching, or numbness before the snake bite: If you had these symptoms on your skin a few days before the snake bite, you are at higher risk of developing PHN.
• If you delay seeing a doctor after a snakebite: If you delay more than three days after the bite, meaning you miss the time limit for taking antiviral drugs, you are more likely to develop PHN.

Why does PHN occur? What is the cause?

`PHN` is caused by damage to nerve fibers during a snake bite. Think about it, nerve fibers carry sensations like pain from our skin to the brain. So when the nerve fibers in the area where the snake bite occurred are damaged, they start sending incorrect, i.e. excessive pain signals to the brain. `Postherpetic neuralgia` means `nerve pain that comes after herpes.` Snake bites are also called `(Herpes Zoster)`.

As we mentioned earlier, snake bites are caused by the same virus that causes chickenpox (Varicella-zoster virus). Once you have chickenpox, the virus stays in your body for life, but it can lie dormant or "silent" for years. It is only when this virus becomes active again that a snake bite occurs. A small percentage (less than 20%) of people who get a snake bite develop PHN.

What exactly are the symptoms of PHN?

The most common symptoms of PHN are:

• Burning, sharp pain, stabbing pain, or a feeling of internal ache at the site of the snakebite.
• Itching or numbness in or near the site of the previous injury.
• The pain is constant or comes and goes. The pain usually lasts for about three months after the wound has healed, but it can last for more than a year.
• Even if a piece of clothing or a very gentle touch touches the painful area of ​​skin, the pain can increase.
• The pain may worsen at night or in extreme heat or cold.

How does a doctor diagnose PHN?

A doctor usually diagnoses PHN based on your symptoms, whether you have had a recent snakebite, and a physical exam. If you have had a recent snakebite and are still experiencing pain at the site of the bite, you likely have PHN. Your doctor may also want to rule out other causes of the pain, but most of the time, no further tests are needed.

Can PHN cause other complications?

Yes, PHN can cause conditions like:

• Feeling tired and exhausted.
• Insomnia.
• The food is tasteless.
• Difficulty concentrating.

If you have long-term PHN pain, it can lead to conditions like depression. Therefore, it is very important to take care of this.

What are the treatments for PHN?

Now let's see what this can do.

If you see a doctor within the first three days of a snakebite, they will likely prescribe antiviral medication. For example, Acyclovir (Zovirax®), Valacyclovir (Valtrex®), or Famciclovir (Famvir®). These medications can help the bite heal faster, stop new bites from forming, reduce pain and itching, and shorten the duration of the pain after the bite heals.

But if your snakebite is not recognized early, or if the opportunity is missed, doctors have several other options to manage your PHN symptoms.

If your pain is mild, a doctor may recommend things like:

• `Acetaminophen (Tylenol®)` or `NSAIDs` (nonsteroidal anti-inflammatory drugs) such as `Ibuprofen (Advil®, Motrin®)`.
• Skin-soothing creams and patches, for example, those containing `Lidocaine (Lidoderm®)` and `Capsaicin (Zostrix®)`.

If your pain is severe, a doctor may prescribe medications like these:

• Some medications used to treat conditions such as epilepsy (called `Antiseizure drugs`), such as `Gabapentin (Neurontin®, Gralise®)` and `Pregabalin (Lyrica®)`, are often used to treat nerve pain.
• Antidepressants, such as Escitalopram (Lexapro®), Quetiapine (Seroquel®), or Amitriptyline, can also help with nerve pain.
• Injecting `Botulinum toxin (Botox®)` into the area of ​​pain.

The important thing is, there is no "this is the best treatment" for PHN. Your doctor may recommend trying more than one medication, or they may prescribe a combination of medications. You and your doctor will discuss your options and decide what is right for you. If your pain doesn't improve after taking your medication, be sure to tell your doctor . It is very important to take all medications exactly as prescribed.

Can PHN be completely cured?

There is no cure for PHN, but it can be managed. For most people, the pain from PHN gradually decreases over time and eventually goes away. As we mentioned earlier, most people will have relief from the pain within one to three months.

Are there ways to prevent PHN from developing?

Yes, this is the most important part! The best way to prevent PHN is to avoid shingles.

• Shingrix® vaccine: The Food and Drug Administration has approved a vaccine to prevent snakebites. This can help reduce your risk of getting a snakebite and developing PHN. This vaccine, called Shingrix®, is recommended for people 50 years of age and older to prevent snakebites. It is a two-dose vaccine, with the second dose given two to six months apart. This two-dose vaccine is 90% effective in preventing snakebites and PHN. You will be protected for at least four years after getting the vaccine.
• Chickenpox vaccine: If you have never had chickenpox, or if your children have had chickenpox, getting the chickenpox vaccine (Varivax) can prevent this infection in the first place. If you have never had chickenpox, you do not have the varicella-zoster virus in your body, so you will not get shingles or PHN.

Who should get the Shingrix® vaccine?

The Shingrix® vaccine is recommended for everyone who is healthy and 50 years of age or older. There is no upper age limit. You should also get the vaccine if you:

• Even if you've had a snakebite before.
• Even if you don't remember exactly when you had chickenpox (about 99% of Americans over the age of 40 have had chickenpox, even if they don't remember it as a child).
• Even if you have previously received the Zostavax vaccine (this vaccine is no longer used in the United States), talk to your doctor about the best time to get the Shingrix® vaccine.

If you have already had a snakebite, you should wait until the wound has healed. Talk to your doctor about the best time to start the Shingrix® vaccine.

What kind of outcome can someone with PHN expect?

There is no standard treatment for PHN symptoms. Depending on the severity of your pain, you may start with over-the-counter medications. If the pain is severe, you may want to try one or more prescription medications. PHN is a difficult condition to treat. In one study, less than half of patients with PHN achieved complete symptom relief.

PHN usually occurs in older people who may have other health problems. This can make treatment and outcomes more complicated. The pain can last for weeks, months, or even more than a year. For some people, the pain can be unbearable. But for most people, PHN pain gradually decreases over time.

Once you have chickenpox, the varicella-zoster virus stays in your body for life. If the virus reactivates and you get a snakebite, seeing a doctor within a few days of the rash and taking antiviral medication can greatly reduce your symptoms. If you do develop PHN, doctors have a variety of medications to help control your symptoms. So don't panic, talk to a doctor and get the right treatment.

Take-Home Message:

Okay, so let's summarize the things we need to remember from this long story:

• PHN is nerve pain that persists even after shingles has healed.
• The main reason for this is the damage to nerve fibers caused by snake bites.
• Older people, those with weakened immune systems, and those who have had severe snake bites are more likely to develop PHN.
• PHN pain can feel like a burning, stabbing, tingling, or itching sensation.
• Although there is no cure for PHN, there are treatments to help control the pain. In most cases, the pain will subside over time.
• Seeking treatment as soon as possible after a snakebite (within the first 3 days) can reduce the risk of PHN.
• The Shingrix® vaccine can greatly reduce the risk of snakebite and PHN. It is recommended for everyone over the age of 50.
• If you think you have PHN, don't hesitate to see a doctor for advice.

I hope this information is useful to you. Stay healthy!

` Postherpetic neuralgia, PHN, snakebite, shingles, herpes zoster, chickenpox, nerve pain, Shingrix vaccine