The Link Between Neuropathy and Shingles
By Russell Chin, MD

EDITOR'S NOTE: Peripheral neuropathy refers to any disease of the peripheral nervous system. It is characterized by a spectrum of symptoms and signs that reflect nerve damage and dysfunction. In recognizing the broad scope of this disease, this article is part of an ongoing series of articles "Recognizing the Broad Scope of Neuropathy" that draws attention to conditions that include peripheral neuropathy as a symptom.

Postherpetic neuralgia (PHN) is a painful condition that often occurs as a result of shingles (also known as herpes zoster). It is estimated that about 10-15% of people with shingles will develop PHN. The risk for developing PHN also increases with age—especially in people over 60—and those who are immunocompromised. Anyone who once had chickenpox is at risk of shingles since the virus may become reactivated years after the initial infection.

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The varicella zoster virus—which causes chicken pox during childhood and sometimes adulthood—enters the nervous system where it remains dormant for many years. Normally, the body’s immune system stops the virus from becoming active; however, with advancing age or an immunocompromised state, the virus reactivates causing shingles. Shingles is an infection of a nerve and the area of skin around it. Typically, the nerves of the chest and abdomen on one side of the body are affected. Even after the shingles rash subsides the pain can persist or recur in the shingles-affected area and is called PHN.

PHN symptoms are usually restricted to the area of skin where the shingles outbreak first occurred. Symptoms include: occasional sharp burning, shooting pains; increased sensitivity to touch and temperature changes; itchiness; and, rarely muscle weakness or paralysis. People suffering from PHN may also develop anxiety, depression, and sleeping difficulties resulting from chronic pain.

There are a variety of therapies available to manage the pain associated with PHN. A 2004 practice parameter of the American Academy of Neurology recommends tricyclic antidepressants (amitriptyline, nortriptyline, desipramine, and maprotiline), antiseizure drugs (gabapentin, pregabalin), opioids, topical lidocaine, and capsaicin to treat PHN. (Amitriptyline is noted to have significant cardiac effects in the elderly compared with nortriptyline and desipramine.¹) A high-dose capsaicin patch (Qutenza®) and a once-a-day prescription of gabapentin (Gralise™) offering 24-hour pain control for people with after-shingles pain has recently become available in the U.S. for PHN. Therapy should be individualized and patients should work closely with their doctors to determine which medication or combination of medications can provide maximum pain relief with no or minimal side effects.

Russell L. Chin, M.D. is assistant professor of Neurology at Weill Cornel Medical College. He is an assistant attending neurologist at New York Presbyterian Hospital and at the Peripheral Neuropathy Center at Weill Cornel Medical College, which is a Neuropathy Association-Designated Center of Excellence.


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