I got shingles from the form herpes zoster trigeminus mandibularis branch in August 2007. Fortunately, external symptoms quickly disappeared. But not the pain, it was treated with gabapentin, lyrica, nerve node block by anesthetist. I still have pain and a numb stiff lower right lip and chin. What else can I do?
Dick van Gerwen, dermatologist
Shingles, or herpes zoster, is almost always accompanied by pain. After the skin abnormalities have disappeared, the skin pain can persist for several weeks. If the pain or dysaesthesia persists for more than 3 months after a herpes zoster, we speak of post-herpetic neuralgia (PHN).
About 5 percent of older patients with herpes zoster still have PHN after 1 year. The risk of PHN is higher in very severe shingles, which is associated with a lot of pain, and in people of old age. Herpes zoster in the face can also cause a lot of after pain.
This pain is very difficult to treat. Antiviral pills, such as Aciclovir or Valacyclovir may reduce the risk of post-herpetic neuralgia. They should then be given as early as possible.
Strong painkillers already in the first stage would also help. Local hormone ointments (corticosteroids) used to be recommended, but they are useless. Some patients respond well to anticonvulsants (Tegretol) or antidepressants (Amitriptyline).
Nerve blocks through injections of anesthetics around the nerve or spinal ganglion are sometimes effective. This can be done through the anesthetist or pain clinic. Sometimes surprisingly good results are achieved with simple topical ointments such as Lidocaine Cream or Capsaicin Cream.
