Postherpetic Neuralgia: Your Questions Answered

Q: Postherpetic Neuralgia: Your Questions Answered

Hello： You mentioned that it took about four days from the onset of back pain to diagnosis and medication (you sought medical attention the day after the rash appeared), which means it was over 72 hours before medication was administered. <br>Will this lead to complications such

Postherpetic neuralgia

Hello Doctor, I initially thought my back pain was just that, so I applied a pain relief patch.
However, I developed a rash and assumed it was a drug rash.
To my surprise, after visiting a dermatologist, I was diagnosed with shingles.
I had many questions at that moment, as I thought shingles only affected older adults.
I would like to ask you a few questions:
1.
It took about four days from the onset of my back pain to the diagnosis, and I started medication only after 72 hours had passed since the rash appeared (I sought medical attention the day after the rash appeared).
Will this delay in treatment lead to complications like postherpetic neuralgia? Should I see a neurologist immediately?
2.
Given my age, should I undergo further testing of my immune system due to this shingles diagnosis?
3.
Once the rash has healed, should I take any precautions for nerve repair? Is there anything specific I should take or do for maintenance, as I am quite anxious about this?
I apologize for the many questions, and I appreciate your assistance.

C, 20~29 year old female. Ask Date: 2020/06/05

Dr. Jiang Junyi reply Neurology

Hello: You mentioned that it took about four days from the onset of back pain to diagnosis and medication (you sought medical attention the day after the rash appeared), which means it was over 72 hours before medication was administered.
Will this lead to complications such as neuropathic pain? Do you need to see a neurologist immediately? A: Generally, antiviral medications are most effective when used within three days; however, using them after three days can still be beneficial and may reduce the risk of postherpetic neuralgia.

2.
Given my age, do I need to undergo further testing of my immune system after developing shingles? A: If you experience recurrent episodes or have unexplained infections, it is advisable to consult an infectious disease specialist for further discussion.

3.
After the rash has resolved, should I pay attention to nerve repair? What should I take or how should I maintain my health? A: Currently, the treatment for neuropathic pain primarily targets the underlying causes, and there are medications that are significantly effective for postherpetic neuralgia.
It is beneficial to supplement with B vitamins and to remind yourself to get up and stretch every half hour to avoid nerve compression and muscle tension that could exacerbate symptoms.
I recommend discussing examination and treatment options with a neurologist.
Wishing you good health and peace.
Dr.
Jiang from the Neurology Department cares about you.

Reply Date: 2020/06/05

More Info

Postherpetic neuralgia (PHN) is a common complication that can arise after an episode of shingles (herpes zoster), which is caused by the reactivation of the varicella-zoster virus. Your experience with back pain followed by the development of a rash is characteristic of shingles, and it’s understandable to have concerns about the potential for lingering pain or other complications.

1. Timing of Treatment and Risk of Neuralgia: The onset of shingles can indeed lead to postherpetic neuralgia, especially if treatment is delayed. Ideally, antiviral medications should be started within 72 hours of the rash appearing to reduce the risk of complications, including PHN. Since you mentioned that you began treatment after this window, there is a possibility that you may experience some degree of nerve pain following the resolution of the rash. However, not everyone who has shingles will develop PHN, and the severity can vary widely. It is advisable to consult a neurologist if you begin to experience persistent pain or other neurological symptoms after the rash has healed.

2. Age and Immune System Evaluation: While shingles is more common in older adults, it can occur in younger individuals, especially those with weakened immune systems. If you are under 50 and have developed shingles, it may be prudent to evaluate your immune system, particularly if you have other health conditions or if there is a family history of immune deficiencies. A healthcare provider can guide you on whether specific tests are necessary based on your overall health and medical history.

3. Post-Rash Care and Nerve Health: After the rash resolves, it’s important to monitor for any signs of nerve pain or discomfort. While there is no specific "nerve repair" regimen, maintaining a healthy lifestyle can support your overall recovery. This includes a balanced diet rich in vitamins (especially B vitamins, which are important for nerve health), staying hydrated, and managing stress. Some patients find relief from nerve pain through physical therapy, gentle exercise, or complementary therapies such as acupuncture. If you experience persistent pain, your doctor may recommend medications specifically for nerve pain, such as gabapentin or pregabalin.

In summary, while there is a risk of developing postherpetic neuralgia after shingles, not everyone will experience this complication. Early treatment can help mitigate risks, and ongoing care and monitoring are essential. If you have concerns about your immune system or experience lingering symptoms, seeking advice from a healthcare professional is the best course of action. Remember to take care of your overall health, as this can aid in your recovery and help manage any potential complications.

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Come try it here.