Introduction
Postherpetic neuralgia is pain persisting for at least 3 months after shingles (herpes zoster) infection. It occurs in about 10% of all patients with shingles, and in over 70% of patients older than 50 years.
Postherpetic neuralgia is usually severe neuropathic pain. It may present as burning, paroxysmal electric shock-like, stabbing or lancinating pain. Ninety percent of patients have allodynia despite sensory loss on routine examination. The skin of the affected area may be depigmented and scarred, but the degree of scarring is not related to the severity or description of pain.
Vaccination of adults reduces the incidence and severity of shingles infection and incidence of postherpetic neuralgia by more than 50%, although 43 people need to be vaccinated to prevent one case of postherpetic neuralgia1. For detailed information about shingles vaccination, including contraindications, see the Australian Immunisation Handbook website.
Pre-emptive treatment with amitriptyline may also reduce the incidence of postherpetic neuralgia, while antiviral agents have no significant preventive effect.