Face / Head / Neck

Pain in shingles (postherpetic neuralgia)

What is Herpes Zoster (shingles)?

Herpes Zoster, also known as shingles, is a virus infection of the nervous system and is accompanied by pain occurring after a herpes infection (post herpetic).

Causes

Herpes zoster occurs when a childhood virus, which at the time caused chickenpox, becomes active again. After recovery from chickenpox, the virus settles into a particular part of the nervous system, such as nerve knots.  As people grow older, resistance to viral infections decreases, until the moment when the herpes zoster virus can gain control. Consequently, the virus spreads from the nerve button(s) to the skin and shingles results, with its characteristic one-sided skin rash in one or more areas of a nerve(s). The little blisters contain the virus and are therefore contagious to anyone who has not built up natural resistance to it. There are cases of grandparents with shingles giving chickenpox to their grandchildren. The reverse is not possible. Pain during shingles is due to inflammation of a sensory nerve in the skin.

Complaints/Symptoms

Patients with shingles report one-side symptoms in a skin area(s) corresponding to an infected nerve knot(s). Since nerve buttons are present all over the body, the pain can occur anywhere within the skin, e.g., face and trunk. Moreover, outside pain, pins and needles, changed skin sensation and itching can also occur. The pain is experienced as burning, pulsating, dull and itching. Pain after a herpes zoster infection can be continuous, with shooting sensations in the scar area. Clothes can be uncomfortable or even painful.

How is the pain diagnosis made?

The diagnosis is based on the pattern of the pain complaints, together with physical and neurological examination.

Do I need any additional examinations?

Physical Examination

At the start of the disease, there is a typical skin rash with redness, pimples and blisters in the painful area. Healed blisters are covered in scabs. The skin rash is generally located on one side of the body and does not cross to the other side. Sensory disturbances, such as dullness, unpleasant pain after pricking or touching the infected skin are frequent.

Additional examinations

  • Diagnostic examination for other non-physical factors important for your pain, have already been done by yourself trough filling out your pain questionnaires.
  • Blood examination for herpes infection

What are the treatment possibilities?

Multidisciplinary Treatment

Depending on the cause of your pain, your pain specialist will decide on whether or not to embark on physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out and, as well as physical treatment, other methods of treatment will be suggested.

Non-physical Treatments

If the results of your pain questionnaire are abnormal, your pain specialist will suggest one of the non-physical treatments listed below:

Physical Treatments

Medication

Other Treatments

Interventional Pain Treatments