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Affecting more than 95% of the world’s population, the herpes varicella zoster virus typically causes a varicella infection or chickenpox — but things could potentially get worse for patients.
When the patient’s immune system becomes compromised due to illness, the virus then reactives from one or more ganglia and may travel to the corresponding skin dermatome causing characteristics of shingles.
Patients who are at risk include cancer, especially lukemia and lymphoma; individuals with HIV; those who’ve undergone bone marrow transplantation; and those on steroids. The disease is less common in blacks than whites, and it’s more common in women. The virus affects 500,000 to one million people in the United States every year.
Postherpetic neuralgia is defined as pain persisting for more than three months after zoster’s onset. The prodromal onset of the disease could be less than a week. After this period, the rash occurs, and it could take anywhere from two to four weeks for the rash to health. That first period is called acute herpetic neuralgia. After 30 days, however, it’s considered subacute herpetic neuralgia. Finally, after three to four months, it’s considered postherpetic neuralgia — and it may last years.
Up to 40% of patients with zoster over the age of 60 years may develop postherpetic neuralgia. Developing this disease, though, is rare for anyone younger than 40. Patients with acute herpes zoster could see a decline in quality of life. Physical factors include chronic fatigue, weight loss and inactivity. Psychologically patients may suffer from anxiety and depression, and they might go out less.
Other consequences of the herpes zoster infection include cerebral angiitis, motor neuropathy, transverse myelitis, polycranial neuritis and stroke.
Treating postherpetic neuralglia is challenging. The amount of pain patients suffer from this disease is overwhelming. Pain management methods for postherpetic neuralglia include symptomatic relief with oral and topical pharmacological agents, nerve blocks and nerve stimulation in some patients. Opioids have also been used to treat the disease, but they should be used with extreme caution.
DISCLAIMER: Dr. Rosenblum is here solely to educate, and you are solely responsible for all your decisions and and actions in response to any information contained herein. This blog and related podcast is not intended as a substitute for the medical advice of a physician to a particular patient or specific ailment.
