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Post-herpetic neuralgia (PHN) is the most common complication and sequela of herpes zoster (HZ) that greatly affects the life and emotional experience of patients. There is no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time. Acupuncture therapy has been confirmed as an effective and safe treatment for PHN.
What is post-herpetic neuralgia (PHN)- the prolonged pain from shingles?
Postherpetic neuralgia (PHN) is the most common complication of shingles. Once a person has chickenpox, the virus will always be in the body. Sometimes the virus becomes active again, causing shingles followed by PHN. PHN affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 50. Around one in five people with shingles will get post-herpetic neuralgia. Many people with post-herpetic neuralgia make a full recovery within a year. But symptoms occasionally last for several years or may be permanent.
Symptoms of postherpetic neuralgia (PHN)
The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on one side of your body.
Signs and symptoms might include:
Pain that lasts three months or longer after the shingles rash has healed. The associated pain has been described as burning, sharp and jabbing, or deep and aching.
Sensitivity to light touch. People with the condition often can't bear even the touch of clothing on the affected skin (allodynia).
Itching and numbness. Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.
Risk factors
When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of:
Age. You're older than 50.
Severity of shingles. You had a severe rash and severe pain.
Other illness. You have a chronic disease, such as diabetes.
Shingles location. You had shingles on your face or torso.
Complications
Depending on how long postherpetic neuralgia lasts and how painful it is, people with the condition can develop other symptoms that are common with chronic pain such as:
How long does postherpetic neuralgia (PHN) last?
Postherpetic neuralgia (PHN) can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.
The pain from PHN can be so severe in some people that it disrupts their life. Researchers don’t know why some people have severe or long-lasting pain and others do not.
Traditional Chinese medicine’s understanding about Shingles
Acupuncture and herbs have been used to help the condition we recognize as shingles for over a thousand years. TCM philosophy views shingles as being related mainly to heat and dampness. As acupuncturists, we see shingles generally presenting in one of three ways:
Liver Fire – the rash will look very red and have a hot burning sensation. This type of herpes zoster outbreak is probably related to a long period of emotional stress or overwork, possibly combined with an unhealthy diet or too much alcohol consumption. Treatment will focus on clearing the heat from the liver-gall bladder system and reducing inflammation. The next steps of care are to reduce stress and boost immune function. [Read more: Stress Management: How to Reduce, Prevent, and Cope with Stress] [Read more: Strengthen your Wei Qi for better immunity]
Damp Heat – this rash will look more like pus or fluid-filled blisters with a very thin skin. Draining dampness and heat from the body with acupuncture and herbs is indicated.
Qi and Blood stagnation – this is usually the long-term condition that can lead to post-herpetic neuralgia. It is also related to older age and an overall weakened immune system, and is more likely to be compounded by fatigue and poor sleep. Treatment will focus on getting the Qi and blood moving freely through the body again. [Read more: Building Blood with more than just iron: How TCM helps with Blood deficiency] [Read more about Qi deficiency: what is it and how do you manage it]
Acupuncture and Herbs Stop Shingles Pain, Outperforms Drugs
Acupuncture and herbs prove effective for the treatment of shingles. Researchers from three independent studies [1-3] conclude that acupuncture and herbal medicine significantly relieve rashes and pain associated with the herpes zoster virus (shingles). Importantly, acupuncture and herbal medicine outperformed antiviral and anti-inflammatory medications, indicating that usual care protocols are suboptimal without inclusion of acupuncture and herbal medicine. -quoted from healthcmi.com
How Can Acupuncture Help postherpetic neuralgia (PHN)
Acupuncture therapy, including acupuncture, electroacupuncture, moxibustion, cupping, bloodletting etc., has been widely used in different pain conditions. Studies have shown acupuncture has a favorable effect on neuropathic pain.[4–6] Acupuncture therapy has already been confirmed to be effective in treating PHN, not only in relieving pain sensation, but also in improving the quality of life, anxiety, and depression.[7-10] Acupuncture and herbs can be used safely, alone or as an adjunct therapy, to relieve the herpes zoster rash and to prevent long-term nerve damage and pain due to neuralgia. TCM treatment also work holistically taking other symptoms of shingles, like headache and stomach upset into the regular course without the need for additional medications. In the long run, TCM can strengthen the immune system and prevent chronic illness.
Reference
Cao Bo (2018) “Clinical Study of Longdan Xiegan decoction Combined with Acupuncture and Moxibustion for Herpes Zoster” Guide of China Medicine Vol.16(25) pp. 174-175.
Zhang Qin, Ding Yujie (2018) “Study on the Effect of Dialectical Treatment with Chinese Medicine and Acupuncture on Clinical Symptoms of Herpes Zoster Neuralgia” Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine Vol.6(25) pp. 134.
Zhao Yun (2018) “Observation on the Effect of Combined Chinese Medicine and Cupping Method on 36 Patients with Herpes Zoster” Traditional Chinese Medicine Vol.16(16) pp.172-174.
Ursini T, Tontodonati M, Manzoli L, et al. Acupuncture for the treatment of severe acute pain in herpes zoster: results of a nested, open-label, randomized trial in the VZV Pain Study. BMC Complement Altern Med 2011;11:46.
Estores I, Chen K, Jackson B, et al. Auricular acupuncture for spinal cord injury related neuropathic pain: a pilot controlled clinical trial. J Spinal Cord Med 2017;40:432–8.
Ahn C-B, Lee S-J, Lee J-C, et al. A clinical pilot study comparing traditional acupuncture to combined acupuncture for treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy. J Acupunct Meridian Stud 2011;4:29–43.
Tian H, Tian Y-J, Wang B, et al. Impacts of bleeding and cupping therapy on serum P substance in patients of postherpetic neuralgia. Zhongguo Zhen Jiu 2013;33:678–81.
Huang S-X, Mao M, Pu I-J, et al. Clinical research on fire filiform needle combined with mild moxibustion for postherpetic neuralgia. Zhongguo Zhen Jiu 2014;34:225–9.
Lei W, Ling Q, Xu Z, et al. Effectiveness of electroacupuncture at Jiaji acupoints (EX-B 2), plus moxibustion and intermediate on postherpetic neuralgia: a randomized controlled trial. J Tradit Chin Med 2020;40:121–7.
Ruengwongroj P, Muengtaweepongsa S, Patumanond J, et al. Effectiveness of press needle treatment and electroacupuncture in patients with postherpetic neuralgia: A matched propensity score analysis. Complement Ther Clin Pract 2020;40:101202.
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