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"What can I do about postherpetic neuralgia?"
I had shingles just about one year ago, and continue to have pain and occasional itching where the rash used to be (on the right side of my torso). I'm a male in my late thirties and have no other health problems. The pain is not debilitating but is enough to sometimes prevent me from sleeping, and OTC painkillers (aspirin, ibuprofen) don't help. I have also tried capsaicin, but that irritates the skin so much that I actually end up with more discomfort rather than less.
Postherpetic neuralgia is an unfortunate but potential complication of shingles (or zoster). It is actually not that common in young patients of your age. I would recommend discussing this with your doctor as there are many treatments for this that are mostly successful. Shingles (or zoster as its medically known) is an infection that occurs commonly. It is actually a viral infection, with the virus actually being the varicella virus -- the same virus that causes chicken pox. The virus actually lives in the nerves. After an eruption in the skin (shingles) a few patients will have continued pain or sensitivity even after the rash resolves. This persistent pain is thought to be due to nerve damage. Treatments for nerve damage are mostly quite successful. As you have tried, topical capsaicin and over the counter painkillers are the most common first line treatments. There are other medicines specific for nerve pain. These include anti-seizure medications -- notably neurontin (gabapentin) or pregabalin (lyrica) which work quite well. Tricyclic anti-depressants also work for nerve pain (at doses much lower than when used for depression). Another medication would be a lidocaine patch -- a medicine that can be placed over the area. Talk to your doctor.
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