Abstract–
Post-herpetic neuralgia (PHN) is a chronic neuropathic pain that persists for months to years after herpes zoster rashes have healed. PHN is characterized by burning, itching, and intense, stabbing pain localized to one side of the body, with intermittent or continuous nerve discomfort. It is most common in people older than 50, with the risk increasing with age. Women are more likely to have long-lasting nerve pain than men, and the weakened immune system can contribute to PHN.
Diagnosis is based on the history of varicella infection and presentation of pain with hypersensitivity or hyposensitivity and abnormal sensations. Physical examination for scar marks is also important. Modern medicine approaches for PHN include tricyclic antidepressants, gabapentin and pregabalin, and lidocaine 5 % patch. Preventing PHN is not definite, but the shingles vaccine can help avoid infection and reduce the risk of getting it again. Homoeopathy medicine is also used to treat PHN.
Many homeopathic medications have indications for PHN, and choosing the right similimum can bring positive and promising effects.
Keywords – PHN, VZV, shingles, neuropathic pain, homoeopathy.
Introduction- Post herpetic neuralgia is chronic neuropathic pain that persists months to years after herpes zoster rashes have healed.
The most typical shingles-related consequence is PHN.
The varicella-zoster virus, or HHV 3, is the primary cause of chickenpox, a pediatric ailment that is mostly benign and manifests as an exanthematous vesicular rash. In the dorsal root ganglia, HHV3 stays latent following primary infection. The sporadic condition known as herpes zoster, or shingles, is caused by latent VZV from dorsal root ganglia reactivating. A unilateral vesicular dermatomal eruption, which is frequently accompanied by excruciating pain, is its defining feature. The most commonly affected dermatomes are those from t3 to l3. One of the main characteristics of post-herpes zoster (PHN) is a unilateral dermatomal pattern of lancinating/burning pain that lasts for three months or longer following an outbreak of hz.
Three phases of clinical symptoms manifest: pre-eruptive, acute eruptive, and chronic. At least two days before cutaneous eruptions, there is burning or discomfort in the afflicted dermatome during the pre-eruptive stage. There may also be non-cutaneous symptoms such as headaches, a general feeling of unwellness, and photophobia.
Multiple umbilicated and painful vesicles emerge during the acute eruptive phase. Frequently, the vesicles rupture, develop ulcers, and finally dry up, this is the most infectious stage. Acute eruptions can recur for two to four weeks.
The chronic phase is characterized by pain in a dermatomal distribution that persists for at least 90 days after a hz outbreak.
History and Physical Examination-
As previously stated, PHN requires a herpes zoster episode. As a result, a history of blistering rash in a dermatomal pattern could be proven. Seldom will the recognizable rash be absent. PHN is characterized by persistent (>3 months) burning or lancinating pain, together with allodynia and/or hyperalgesia at or around the site of the rash.
When a patient with postherpetic neuralgia is examined physically, the following may be found:
- Changes in feeling, either hypoesthesia or hypersensitivity, in the affected areas;
- Evidence of cutaneous scarring on a previous herpes zoster location.
- Allodynia, the production of pain by non-noxious stimuli like mild touch
Etiology- Varicella zoster virus[VZV]
Clinical Features:
Postherpetic neuralgia is characterized by burning, itching, and intense, stabbing pain that is localized to one side of the body. There may be intermittent or continuous nerve discomfort. Areas of excoriation from scratching or scarring from the previous shingles infection’s vesicular rash may be seen in the affected areas. Due to the frequent involvement of the thoracic nerve fibers, the pain is frequently restricted to the trunk.
The cervical and trigeminal nerves in the neck, arm, and face are other frequently impacted sites.
Risk Factor – Shingles most commonly occur in people older than 50.
- The risk of developing PHN increases with age
- Women seem to be more likely to have long-lasting nerve pain than men.
- Weakened immune system
Complication
Depending on the duration of post herpetic neuralgia and how painful it is, the following complications can arise in patients:
- Depression
- Fatigue
- Disturbed sleep
- Lack of appetite
- Impaired concentration
Differential Diagnosis: Differential diagnosis will differ based on the affected dermatome site.
Trigeminal neuralgia
Bell’s palsy
Appendicitis
Colitis
Cholelithiasis
Diagnosis-
Diagnosis is mainly based on the history of varicella infection and presentation of source of pain and presentation of pain with hypersensitivity or hyposensitivity and abnormal sensations .physical examination for scar marks.
Treatment- Aims to manage pain and improve quality of life.
Modern Medicine Approach–
First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch
Homoeopathic Approach- homoeopathy offers deep acting remedies to address PHN. Here are some homoeopathic medicine that may help-
- Rhus tox-
vesicular eruptions yellowish, burning sensation, itching aggravation by scratching. Generally patient with marked restlessness .Conditions that are accompanied by fever. Tingling sensation.. Most commonly indicated remedy for post herpetic Neuralgia.
- Ranunculus bulbosus-
Burning and intense itching ;worse ,contact. Herpetic eruptions ,with great itching. Shingles ,bluish vesicles.herpes on cornea.vesicle on cornea, with intense pain, photophobia and lacrimation
- Arsenicum album-
Burning pain is very severe at night. Arsenic album is also given to manage itching on the skin. Restlessness can attend to these symptoms. It is also indicated to manage active herpes zoster outbreak when marked burning pain is felt in the eruptions.
- Prunus spinosa-
Prunus spinosa is a remedy indicated for herpes zoster and neuralgic pain .ciliary neuralgia ,bursting pain in the right eyeball.
- Mezereum-
Pain of various kinds with chilliness and sensitivity to cold air action on face, tingling and numbness.pain in the face may get worse while eating, action is mainly on the facial nerve, burning pain, itching at night, aggravation by warmth.
- Hypericum-
Neuritis, tingling , burning, numbness. Sensations of crawling in hands and feet. Violent pain.
- Sempervivum tectorum-
Remedy recommended for herpes zoster, clinically effective in tincture form.
Kalmia latifolia:vesicular yellowish eruptions, exceedingly painful, neuralgia on face, right sided affection, stitches in the tongue stitches and tearing in lower jaw. Most indicated for neuralgic pain in the face.
Prevention-
- There’s no definite way to prevent post-herpetic neuralgia.
- Having the shingles vaccine will help you avoid getting the infection in the first place. If you’ve had shingles before, the vaccine will also reduce your risk of getting it again.
- Additionally, to promote your general well-being throughout PHN, think about making other lifestyle modifications, including stress management, eating a good diet, and continuing to be physically active.
References:
| 1. | Gruver c, guthmiller kb. Postherpetic neuralgia. Statpearls publishing; 2023. |
| 2. | Penman id, Ralston sh, strachan mwj, hobson r, editors. Davidson’s principles and practice of medicine. 24th ed. London, england: elsevier health sciences; 2022. |
| 3. | Harrison tr, braunwald e. Harrison’s principles of internal medicine. 15th ed. New York, ny: mcgraw-hill; 2002. |
| 4. | Boericke w, boericke oe. Homoeopathic materia medica with repertory comprising the characteristic and guiding symptoms of the remedies. 2nd ed. Savage rb, editor. Sittingbourne, england: homoeopathic book service; 1990. |
| 5. | Nair pa, patel bc. Herpes zoster. Statpearls publishing; 2023. |
| 6. | Me a. Homoeopathic medicines for post-herpetic neuralgia [internet]. Homeopathy resource by homeobook.com. Homeobook; 2023 [cited 2024 july 5]. Available from: https://www.homeobook.com/homoeopathic-medicines-for-post-herpetic-neuralgia/ |
About the Author:
Dr. Sanchita singh
M.d scholar
( practice of medicine)
Govt. Hom. Medical college, bhopal.
Under the supervision of
Dr. Praveen Jaiswal, m.d. (hom.),
Hod of practice of medicine at government homoeopathic medical college, bhopal
