Brief Answer:
“Post herpetic neuralgia” or PHN.

Detailed Answer:
Hello,

Welcome and thanks for posting your query to the forum.

I can understand your concern for the pain persisting after shingles.

After thoroughly analyzing the complete condition I can make out that you are presently suffering from the typical condition known as “Post herpetic neuralgia” also simply known as PHN.

To tell you medically and simply about your condition- You suffered form the condition of Herpes zoster (Shingles) four weeks ago. It is a viral infection caused by same group of viruses which causes chicken pox in our early life. It occurs as rash and blisters on one side of body only which can occur either on head region or on chest region or on flank region. We consider the occurrence as worst in case if occurs on head region and of less severity if occurs on chest and breast region (as in your case).

There is inflammation of the nerves (in the skin only) by the viruses in the particular side of the body which actually causes the rash as well as the pain part and the blistering. As per age it may be limited to a small part or may be widely distributed but only one side of body strictly.

When zoster occurs before 40 years of life then it is bit mild of all and never causes much of the rash or painful symptoms later than 2-4 weeks. As the age increases beyond 40 years it proportionately increases in severity. I have seen people having severe pain as well as rash if shingles occurs post 50-60 years of age.

As I already said it is mild in pre 40s and more severe after 50-60s because of the fact that as the age progresses there is less tendency to combat this viral illness due to aging. Due to this there is more damage to nerves and then it turns into your condition called as “Post herpetic neuralgia”.


The only problem lies in the oversensitivity of the skin due to inflammation of nerves. SO you may perceive higher pain after touching of the clothes or due to movements in different forms as shooting pain or stabbing pain or burning pain. All these things are quite very usual at your age so do not worry.

If I were your treating dermatologist then rather than pain killers I would have prescribed you the medicines which can reduce the oversensitivity of the nerves.

In your kind of cases I generally prescribe Pregabalin in day time (150 mg) and low-dose (10 mg) amitriptyline hydrochloride at night time after meals. I generally start with this dose and upgrade according to the response.
These are the medications which will help us out in reducing the kind of excessive sensitivity of the nerves at the affected region.

The only side effect of the tablets is sedation which is managed within few days to few weeks of time. Even if the severity of pain is not reducing initially then would have added a pain killer such as paracetamol with tramadol on as and when required basis.

An additional tablet containing Cyanocobalamin or vitamin B12 also helps. It can be taken twice daily to help in early healing of nerves. It may take several months to be completely alright so have patience and do not worry about the situation.

Swimming or other exercises have no role in reducing the pain as it is not muscular in origin but you can go for swimming as is good for health.

I hope the information will help you. I will be glad to guide you any further.

My best wishes for early recovery from the problem.

Regards, Dr Sanjay Kumar Kanodia
MD -Dermatology

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Brief Answer:
Pregabalin & amitriptyline are under prescription

Detailed Answer:
Hello,

Welcome again to the forum and thanks a lot for your swift follow up.

Both Pregabalin and amitriptyline hydrochloride are prescription medications and must only be taken under medical guidance only. In my patients I prefer to give a combination which helps a lot in every type of pain related to PHN.

For Vitamin B12 it is present in all multivitamin tablets as combination or as alone dose also so can be obtained as over the counter drug.

These are to be taken for long term period of few months to get best relief. You can apprise your treating doctor by my suggestions and take further guidance accordingly.

I hope all these informations will help you best in dealing with your present condition. I will be glad to guide you any further or if not then can close the query and rate the answer.

My best wishes for early recovery from the problem.

With regards,

Dr Sanjay Kumar Kanodia
MD -Dermatology

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