A Personal View
David Elpern -- Dermatologist
Around 15 - 20% of patients who have shingles will develop pain that lasts for months after the acute lesions subside. By definition post-herpetic neuralgia (PHN) is the term used for pain that is present six weeks after the blisters have resolved. Wikipedia has a fine section on PHN . So does The National Library for Health's Prodigy system if you want more in-depth and evidence-based information.
I would like to add some ex-cathedra comments. I have helped care for patients with PHN for over 30 years and read about this disorder with great interest. It is unusual in young persons who have had shingles. These individuals seem to perceive pain differently. In patients who are depressed, sad or chronically ill initially the incidence of PHN is higher. These people seem to focus on their pain and don't let go of it. Understanding the Gate Control Theory of Pain helps one to understand this.
"In their seminal paper "The Tragedy of Needless Pain," Melzack and Wall assert that pain is a fundamental human experience, and requires an integrative understanding of that whole experience, and every choice we have made, that has formed our own "gates". They frame the choice to deal with pain or ignore it as moral: if the brain can control pain, we who know that must make use of that capacity, and in turn take control of pain. Only by doing so can we achieve control of the larger causes of all of the pain that humans cause each other by carelessness, hatred, and failures of empathy - which might extend beyond humans.
The impact of this theory on medical treatment for pain has been profound, and has made it a multi-disciplinary field. A major advantage of the theory is that those being taught pain control techniques can actually be told why they work. This seems to play a major role in achieving results - which is explained most readily by psychoneuroimmunology, in which the nerves are seen as the link between the immune system and sensory and cognitive experience."
Please read about the Gate theory if you are interested. But what does this mean for post-herpetic neuralgia?
In my opinion PHN is a scourge for people who focus on the pain of
shingles and then believe they will not get better. In some cases,
this is a self-fulfilling prophesy. The media, pain clinics and some physicians nurture
this fear by promising interventions which inadvertently may actually prolong the
pain. It is very important to work with shingles patients early on to help prevent them from focusing on the pain.
I tell them to be active. To go to work if they can. To keep one's mind off the pain. Watch funny movies, get out if they can, go to dinner with one's partner or friends. Don't sit around feeling sorry for yourself. Yes. This is difficult, but there does seem to be something to this. It may well explain why older individuals (who are retired and can sit around if they need to) or people with chronic disease suffer more than active busy people.
I know this is controversial and there have been few or no studies. These have been my observations and I think they explain why kids and young adults rarely develop PHN (most are just to busy to do so!). Besides, these techniques are benign, cheap and have no down side.
