Post Herpetic Neuralgia: A Review and Journal Club

In this week's episode of the Spine & Nerve podcast Dr. Nicolas Karvelas and Dr. Brian Joves discuss Post Herpetic Neuralgia (PHN), the most common complication of Herpes Zoster (also known as Shingles, which is caused by reactivation of the Varicella Zoster Virus).
PHN is defined by pain that is typically burning or electrical, and may be associated with allodynia or hyperesthesia in a dermatomal distribution. Pain from PHN is typically sustained for at least 90 days after the rash. PHN is caused by nerve injury due to the inflammatory response induced by viral replication within the nerve. Epidemiologic studies have found that PHN occurs in about 20% of patients who have Herpes Zoster. With the relatively recent development of the preventative vaccine Shingrix (which has been found to be 97% effective in preventing Herpes Zoster) it is anticipated that the total prevalence of Herpes Zoster and PHN will decrease. However, research has repeatedly demonstrated that immunocompromised patients are at a significantly increased risk for Herpes Zoster and PHN (20-100 times increased risk of development of PHN). As of today, the Advisory Committee on Immunization Practices has not cleared immunocompromised patients to receive the Shingrex (or Zostavax) vaccine; therefore for multiple reasons PHN will most likely continue to be a prevalent diagnosis.
Treatment options for PHN include physical modalities (TENS, desensitization), topical medications (including Lidocaine 5% patch, and Capsaicin), oral medications (including Gabapentin, Pregabalin, Tricyclic Antidepressants), and procedures.
Listen as the doctors review Herpes Zoster, PHN, and a recent research article evaluating the effect of the Erector Spinae Plane Block in regards to prevention of PHN once Herpes Zoster has already developed.
This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek counsel with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.
References:
1. Zeng-Mao Lin, MD, Hai-Feng Wang, MD, Feng Zhang, MD, Jia-Hui Ma, MD, PhD, Ni Yan, RN, and Xiu-Fen Liu, MD. The Effect of Erector Spinae Plane Blockade on Prevention of Postherpetic Neuralgia in Elderly Patients: A Randomized Double-blind Placebo-controlled Trial. 2021;24;E1109-E1118.
2. Dooling KL, Guo A, Patel M, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. MMWR Morb Mortal Wkly Rep 2018;67:103-108.

Пікірлер: 103

  • @christinaparkerbrown
    @christinaparkerbrown Жыл бұрын

    I’m on year 3. Horrible constant sunburn pain. Also shooting pain at times - just awful.

  • @princessmariam7366

    @princessmariam7366

    Жыл бұрын

    I must appreciate Doctor Ani John on KZread for helping me and my husband in getting rid of Shingles virus permanently after so many years in pain God sent you to save my family with your natural herbs and roots all thanks to you doctor you are a God sent keep saving lives sir I really appreciate all you have done for me and my family my God bless you richly sir🙏❤️

  • @SuperFacecloth

    @SuperFacecloth

    18 күн бұрын

    Me too. You are not alone.

  • @JK-bu1gk
    @JK-bu1gk Жыл бұрын

    Thank you Dr Karvelas and Dr Joves for making this video! I appreciate hearing all the information and timelines. I'm not out of the woods, yet, but what seems to have helped me the most are the Lidoderm patches you mentioned. I believe a key is starting the patches as soon as the scabs flake off. Also vitamins D3 and K2 that was on a video Dr Berg did on shingles seems to have helped a bit.

  • @peowski1
    @peowski1 Жыл бұрын

    Thank you for bringing attention to this very important subject. I visited the ER on 10/4/23 and all my tests came back negative. I was in terrible pain and the ER doctor said it could be Shingles, but I had no rash. It took 8 days for the rash to appear and by then the pain was off the charts. I could not get in to see a doctor right away, so I saw a PA who prescribed Valtrex and 600 mg per day of Neurontin. No relief was in sight. I was up nights crying and pacing for weeks. When I finally spoke with the doctor, she put me on Prednisone. Even though it been 3 weeks since the rash had appeared, I feel the doctors and PA did all the right things. I still have intermittent pain and constant allodynia from PHN, along my waist to my back. The Neurontin was making me sleep all day and I had a hard time waking up. I went off of it gradually on my own because my former doctor told me to stay on it. I have since changed doctors and she put me on a small does of Nortriptyline. Again, it was not well-tolerated, so she told me it was okay to stop. I can function to a certain point, but I become fatigued with physical activity, stress, and prolonged concentration. Still, I feel lucky. I am on a PHN community called Stuff That Works and people are still suffering greatly after many years.

  • @graceliljeblom1436

    @graceliljeblom1436

    Жыл бұрын

    OMG, I had the pain before the breakout as well. The pain is horrendous! I started Gaba pentin and just finish the prednisone. Today was so painful that it just stops your world.I pray my journey will not include continued PHN once the rash clears.

  • @Ken-tu2sv
    @Ken-tu2sv4 ай бұрын

    More about the after effects of the pain from shingles virus needs to be explained to the public. The adds on TV and the doctor's are not giving the total after effects of this virus.

  • @xaviertaylor759
    @xaviertaylor7592 жыл бұрын

    Thanks for sharing - lots of useful information and promising research. I have recently started with PHN, and its a concern that it can last so long. I hope mine clears up sooner, rather than later.

  • @energyworker2012
    @energyworker2012 Жыл бұрын

    great info if i were a medical person - have had nerve pain from shingles I had over 3 years ago - where can i go to get info to get some releif

  • @angelwingstn3392
    @angelwingstn33922 жыл бұрын

    I have PHN now. This is a horribly painful condition. I am on a ton of medications. Have had three unsuccessful nerve blocks.

  • @SuperFacecloth

    @SuperFacecloth

    18 күн бұрын

    Three years for me. The meds made my life worse but everyone is different. Tried meds for three years and now I'm medication free. There are ways to mentally deal with certain levels of the pain but that doesn't mean it goes away, you can just learn to live with it. I couldn't learn to live with the medication and the pain.

  • @charlessmith263
    @charlessmith263 Жыл бұрын

    So in Post Herpetic Neuralgia - the Zoster viral cells seem to have a long half-life (like radioactive materials like U-235 that have this half-life) which can cause the virus to be active and replicate nearly endlessly for up to 3 years after diagnosis. This pain is not your normal type of flank pain that comes from kidney stone problems. The pain of PHN itself can be very, very debilitating.

  • @vasia8487
    @vasia8487 Жыл бұрын

    A question I had shingles in my knee but the 3 months now is it in the opposite side of the body near my waist. Is it possible?

  • @carolguthrie1792
    @carolguthrie1792 Жыл бұрын

    My mom is 93. She’s been experiencing extreme PHN due to shingles for 3 months now. She’s taking 600 mg gabapentin 3 x’s per day. It does help with the pain somewhat

  • @princessmariam7366

    @princessmariam7366

    Жыл бұрын

    I must appreciate Doctor Ani John on KZread for helping me and my husband in getting rid of Shingles virus permanently after so many years in pain God sent you to save my family with your natural herbs and roots all thanks to you doctor you are a God sent keep saving lives sir I really appreciate all you have done for me and my family my God bless you richly sir🙏❤️

  • @robbrien8506
    @robbrien8506Ай бұрын

    The earlier interventional spinal nerve block you mention, does that involve the trigeminal nerve, or for people with shingles on their upper regions such as neck or head? If not, is there a similar early interventional nerve block higher up the spine which replicates the success of the study you quote? Either way, I would be willing to take various nerve blocks asap because my preexisting, not awful trigeminal neuralgia was slammed into the pain and intractable itching stratosphere by getting a full blanketing of shingles, of course, in my neck, scalp and ear area, prime trigeminal nerve territory aggravated by some pinched nerves in the c2-c4 areas. So basically a tripling effect of 1. the pinched nerve, 2. preexisting trigeminal neuralgia amplified by 3. an incredibly severe case of ear, neck and head shingles with non stop zapping and scratch until you bleed pain. So far massive doses of pregabalin, carbomezapine, dilaudid, as well as lidocaine, cbd oil, even ketamine topicals have done nothing. A sub cutaneous nerve block was given in the upper c level spine, but nowhere near the nerve root. It helped a bit with the scratching the scalp to the bone bit, but didn't address the excruciating neck, ear and lower scalp pain that makes night time a sleepless nightmare. Still hoping for another block to address this area, but our major city has only one pain clinic that you have to wait 4 months to get into to get a pain block that takes 2 minutes to administer in an ER. I do keep 2 VERY graphic photos on my phone of my neck and ear and part of my face in full shingles lesions bloom, because when doctors are looking at you writhing in pain and your face, ear, and neck look pleasantly pink, post-lesion healing, and now appear barely touched by shingles, they need that jolt to see just HOW extensive and severe the shingles actually presented to appreciate the potential and likely severity of the current nerve damage. The irony is, that when I was in full grotesque lesions bloom a month ago for only a week, my pain was 1/100th of what it is now when my skin looks normal. I had no idea what lay ahead for me, and am now DESPERATELY trying to get the intervention I need before it's TOO late.

  • @EzeyimPascal

    @EzeyimPascal

    Ай бұрын

    I understand how you feel believe me, I have been through this same pain before and finding the best cure for Herpes, Shingles (HSV1&2 ) contact Dr.Ani John via KZread channel he saved my life from this same virus I will always recommend him because he is the best herbal doctor in the world..

  • @sylviagraham6183
    @sylviagraham6183 Жыл бұрын

    I’m 3 months in with PHN & desperate.

  • @francesmartinez1424

    @francesmartinez1424

    Жыл бұрын

    Me too. 5 1/2 years 😢

  • @lilianaordonez5474
    @lilianaordonez5474 Жыл бұрын

    I am going through shingles, and nhp but I refuse to take neurontin ( gabapantin) I read a lot of stories about it.

  • @joseflores38

    @joseflores38

    16 күн бұрын

    Use Pregabalin, dosage from 75mg to 150mg. It works. Tolerance is always a factor, up the dosage as medically recommended.

  • @chilidillo
    @chilidillo Жыл бұрын

    I have a question, I have had 5 outbreaks over 8 years on 4 different dermatomes. My ignorance during the outbreaks led me to scratch and massage where the pain was. T1 back was the worst and I massaged it a lot. 2 months after the last time the sores healed, the PHN started, now 3 months after the PHN started, the pain has slowly moved from the root to the shoulder blade. Did I cause this?

  • @joseflores38
    @joseflores3816 күн бұрын

    Use Pregabalin, dosage from 75mg to 150mg. It works. Tolerance is always a factor, up the dosage as medically recommended.

  • @sonergunalp4886
    @sonergunalp4886 Жыл бұрын

    please write drug names for pain treatment.

  • @princessmariam7366

    @princessmariam7366

    Жыл бұрын

    I must appreciate Doctor Ani John on KZread for helping me and my husband in getting rid of Shingles virus permanently after so many years in pain God sent you to save my family with your natural herbs and roots all thanks to you doctor you are a God sent keep saving lives sir I really appreciate all you have done for me and my family my God bless you richly sir🙏❤️

  • @TinaVaughn007
    @TinaVaughn0072 жыл бұрын

    My Dad is still suffering PHN after 4 years from the shingles rash. He has never worn a vest due to it touching his skin and only wears a shirt if he needs to go out. Is there any cure for the damaged tissue, would a back massage help at all?

  • @mohdshakir4613

    @mohdshakir4613

    Жыл бұрын

    Hows father now

  • @TinaVaughn007

    @TinaVaughn007

    Жыл бұрын

    @@mohdshakir4613 Still suffering phn using lidocaine patches to help. He got a serious attack.

  • @christinediecidue9741

    @christinediecidue9741

    Жыл бұрын

    Hi friend dr Berg on u tube has a video on shingles. Rub the opposite side of the shingle area to relieve pain . I have shingles myself it does stop the pain for a little while but the pain comes back later on . Watch the video see what you think . God bless.i pray for him

  • @JK-bu1gk

    @JK-bu1gk

    Жыл бұрын

    @@christinediecidue9741 I agree, massaging the mirror side did help short term. What seems to have helped me besides the Lidoderm patches is vitamins D3 and K2 that dr Berg suggested. God Bless.

  • @yvonnesheehan9079

    @yvonnesheehan9079

    Жыл бұрын

    My 93 old Dad is in the same pain and cannot take a shower as the spray of water is too sensitive on his skin. He cannot wear a vest either. I wish I could help him.

  • @tinahead8205
    @tinahead8205 Жыл бұрын

    I have horrible nerve pain from shingles.

  • @princessmariam7366

    @princessmariam7366

    Жыл бұрын

    I must appreciate Doctor Ani John on KZread for helping me and my husband in getting rid of Shingles virus permanently after so many years in pain God sent you to save my family with your natural herbs and roots all thanks to you doctor you are a God sent keep saving lives sir I really appreciate all you have done for me and my family my God bless you richly sir🙏❤️

  • @yvonnesheehan9079
    @yvonnesheehan9079 Жыл бұрын

    My Father is 93 and is suffering with shingles pain 18 months now with no pain relief. He was never given a vaccine. He has had several neuro blocks but nothing has helped. Can anybody recommend something for this pain and sensitive skin please ? Ireland 🇮🇪

  • @brianlukonde4100

    @brianlukonde4100

    5 ай бұрын

    Pregabalin 75-300mg

  • @yvonnesheehan9079

    @yvonnesheehan9079

    5 ай бұрын

    @@brianlukonde4100 been there done that to max dosages for his age. Thanks anyway.

  • @ibijokeolufunwa5313

    @ibijokeolufunwa5313

    2 ай бұрын

    I’m 9:03

  • @user-qp7fn9wz2j
    @user-qp7fn9wz2j2 ай бұрын

    I am to have spine surgery. Had shingles at age 13. Will the surgery reactivate the shingles?

  • @EzeyimPascal

    @EzeyimPascal

    Ай бұрын

    I understand how you feel believe me, I have been through this same pain before and finding the best cure for Herpes, Shingles (HSV1&2 ) contact Dr.Ani John via KZread channel he saved my life from this same virus I will always recommend him because he is the best herbal doctor in the world..

  • @s.a.g.8131
    @s.a.g.81317 ай бұрын

    I'm 36 and currently getting over shingles. I was diagnosed the first week of October and the pain is just getting worse and worse even after the blisters have sabbed over and the scabs have fallen off, there's still pain. I was wondering if it normal for the pain to still be present at this stage of recovery. My doctor just tells me to use topical lidocaine and ibuprofen but it doesn't do much to take pain away. Any thoughts?

  • @Raspberrycooki1

    @Raspberrycooki1

    3 ай бұрын

    You might have nerve pain and you need prescribed pain killers

  • @SuperFacecloth

    @SuperFacecloth

    18 күн бұрын

    Sounds exactly like me 3 years ago. Sounds like PHN. Has anything changed for you?

  • @s.a.g.8131

    @s.a.g.8131

    10 күн бұрын

    @SuperFacecloth I have since been diagnosed with PHN. The pain is still present and I take gabapentin and ibuprofen with topical lidocaine twice, every day. It's a bitch TBH.

  • @aliciaturnour5491
    @aliciaturnour5491 Жыл бұрын

    I would like to hear about facial PHN in the left eye, scalp, ears with severe pain and itching burning nothing helps

  • @stevegcq

    @stevegcq

    10 ай бұрын

    You probably have a

  • @stevegcq

    @stevegcq

    10 ай бұрын

    disease called, 'Topical

  • @stevegcq

    @stevegcq

    10 ай бұрын

    steroid withdrawal'.

  • @stevegcq

    @stevegcq

    10 ай бұрын

    Look up some vids on it.

  • @stevegcq

    @stevegcq

    10 ай бұрын

    I have to split the comment to get around the censorship algorithms.

  • @123Goldhunter11
    @123Goldhunter117 ай бұрын

    How about nerve burning?

  • @janicepaul9957

    @janicepaul9957

    Ай бұрын

    B complex vitamin supplements Are good for the nervous system so I thought that would work to make sure we get enough the B complex vitamins to calm our nerves. The vitamins are for calming the body study. It don’t do it cause I tell you do it cause you agree what they’re saying and you want to try it Might help

  • @offorcosmas5713
    @offorcosmas5713 Жыл бұрын

    Thank you Dr Aigboh , you did all the good work, your sincerity that brought me the trust and belief of getting cured, I'll be so happy to watch your business expand just as it has helped a lot of people with different sickness and viruses.~~~~~

  • @teresacrispim8415
    @teresacrispim8415 Жыл бұрын

    My husband is having this now . Help

  • @princessmariam7366

    @princessmariam7366

    Жыл бұрын

    I must appreciate Doctor Ani John on KZread for helping me and my husband in getting rid of Shingles virus permanently after so many years in pain God sent you to save my family with your natural herbs and roots all thanks to you doctor you are a God sent keep saving lives sir I really appreciate all you have done for me and my family my God bless you richly sir🙏❤️

  • @tsunduesouvenir6659

    @tsunduesouvenir6659

    Жыл бұрын

    Dr ani John add please

  • @times461

    @times461

    2 ай бұрын

    How is he today,?

  • @sylviagraham6183
    @sylviagraham6183 Жыл бұрын

    I’ve been on about everything & so far no help.

  • @princessmariam7366

    @princessmariam7366

    Жыл бұрын

    I must appreciate Doctor Ani John on KZread for helping me and my husband in getting rid of Shingles virus permanently after so many years in pain God sent you to save my family with your natural herbs and roots all thanks to you doctor you are a God sent keep saving lives sir I really appreciate all you have done for me and my family my God bless you richly sir🙏❤️

  • @SuperFacecloth

    @SuperFacecloth

    18 күн бұрын

    Same. I got off all the meds. "there was an old lady that swallowed a fly"...

  • @joseflores38

    @joseflores38

    16 күн бұрын

    Use Pregabalin, dosage from 75mg to 150mg. It works. Tolerance is always a factor, up the dosage as medically recommended.

  • @rachaelstewart3497
    @rachaelstewart3497 Жыл бұрын

    So it is hard I am 46, Covid in January 2021. Woke up end of May with horrible pain in back wrapping around my to my abdomen. After 6 CTs, 5 ultrasounds, 3 MRIs, 1 transvaginal ultrasound, I think 12 X-rays, 1 HIDA scan, 1 small bowel follow through, and colonoscopy. Oh no an upper GI. Over 11 months my ortho doc finally landed in this. Next week cortisone in T7-T9 (well between) I am hopeful. Still no one will give me he vaccine.

  • @rachaelstewart3497

    @rachaelstewart3497

    Жыл бұрын

    Also it started in May I never had a n eruption of blisters or any skin irritations. The pain is positional, but also like a constant “stitch” at ALL TIMES! then 6 weeks late in July I developed the typical burning pain but in the opposite side and on the front with a very small eruption. But it was shingles. Lasted about 3 weeks then gone.

  • @emiliocabanisas94

    @emiliocabanisas94

    Жыл бұрын

    @@rachaelstewart3497 my grandmother have this now. ang the burning pain attacks 20+ times e/in the 24hr. The duration of her pain attacks almost a minute

  • @chilidillo

    @chilidillo

    Жыл бұрын

    @@rachaelstewart3497I am so sorry, I know the stitch well. Shingles CAN and DOES occasionally occur in adjacent dermatomes. I have PHN in T1 Dorsal left from the root to my armpit, but I am now developing the sores and numbness on T1 Right. My first outbreak was on L1; I have had 5 total outbreaks on 3 different dermatomes

  • @rhondarowe6447

    @rhondarowe6447

    Жыл бұрын

    @Rachael Stewart me almost the same 47 multiple tests finally had emg test and sports medicine Doc diagnosed me. Countless tests U/S x 3 CT chest meds Cervical mri, xray, stat mammogram 3 times blood draws

  • @rachaelstewart3497

    @rachaelstewart3497

    Жыл бұрын

    @@rhondarowe6447 how are you now? I turned 47 in August and am still struggling with the pain. The steroid shot didn’t work. It was actually done on my birthday. Doc set me up for a Ganglion root stimulator implant that was scheduled for last Monday, but insurance denied it. I have another appointment with him on Wednesday to discuss other things. Now on lyrica after being on gaba for months and having all kinds of memory issues. Memory is getting a little better but pain isn’t nearly as controlled. Gabapentin didn’t take it away completely but better than lyrica.

  • @jaenokhiria6693
    @jaenokhiria6693 Жыл бұрын

    I thank #Dr Ofenmu on KZread for your perfect and honest work. You were able to restore my health and sex life with the help of your Roots Herbs. I pray that God will give you more wisdom to continue your perfect works to help others as you have helped me.

  • @donmcdougall522
    @donmcdougall5227 ай бұрын

    I’m 84 nearly a year on Shingles …I had both the shots a year before… with all us old people getting it ,is there something wrong with the Med and Big Pharma System? Hope the Meds are enjoying the Billions. Too many uneducated people.Hope this is not a real conspiracy.

  • @donnapolk3528
    @donnapolk35283 ай бұрын

    Would you please use words non medical professionals can understand

  • @davinagreen3875
    @davinagreen38753 ай бұрын

    OMG! This is so long winded especially for elderly people. So much unnecessary stuff.

  • @EzeyimPascal

    @EzeyimPascal

    Ай бұрын

    I understand how you feel believe me, I have been through this same pain before and finding the best cure for Herpes, Shingles (HSV1&2 ) contact Dr.Ani John via KZread channel he saved my life from this same virus I will always recommend him because he is the best herbal doctor in the world..

  • @imasuenosaro9839
    @imasuenosaro9839 Жыл бұрын

    WOW😊, Doctor Ani John turned my life around with his supernatural Herbs cure remedies, I have been filled overwhelming joy😊🙏❤️

  • @noluthandonyandeni7882

    @noluthandonyandeni7882

    Жыл бұрын

    Name please.

  • @josphatmwale2952

    @josphatmwale2952

    9 ай бұрын

    What kind of herbs did you use, please help am in pain right now in bed because of the pain after shingles,may you help me please

  • @user-rg7md1zn8n

    @user-rg7md1zn8n

    4 ай бұрын

    Hi ! Can you please give me the name of herbs are you using? It would be a big help for my Abba your medication. Thank you for the help

  • @elvinapetrashko1696
    @elvinapetrashko169611 ай бұрын

    It would be nice if doctor did not read but use just regular speech

  • @offorcosmas5713
    @offorcosmas5713 Жыл бұрын

    Thank you Dr Aigboh , you did all the good work, your sincerity that brought me the trust and belief of getting cured, I'll be so happy to watch your business expand just as it has helped a lot of people with different sickness and viruses.~~~~~