What is Postherpetic Neuralgia?

Herpes zoster is a virus that causes chicken pox in childhood.  In adult life, if it recurs, it causes “shingles”, an outbreak of small lesions on the skin.  They usually occur in the distribution of a nerve root.  If the nerve root is the trigeminal nerve, the outbreak will occur on the face, usually in V1, the forehead and eye.  The outbreak is painful.  If you have this you should seek immediate medical attention, since early drug treatment can prevent chronic pain.

About 10% of people with a zoster infection develop chronic pain in that distribution.  It’s called “postherpetic neuralgia.”  The best medical treatments involve topical application of capsaicin cream.  It burns, a lot.  But if you use it for 2-3 weeks the postherpetic pain often diminishes.

If your pain is totally incapacitating, you may be a candidate for an operation called the “nucleus caudalis dorsal root entry zone lesion (DREZL) procedure.  This involves surgery, under general anesthesia, where a needle is placed into the pain center of the brainstem and lesions are made.  At UF, we have performed many of these procedures.