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"Neuralgia"

6 . "found capri moon's post - rajah :)"
Posted by ruby on Apr-27-99 at 10:44 AM (EST)

Jewel,

Here's some info I lifted from the Herpesite. I hope it helps! I'll post it for another person checking into "numbness", too.

Post Herpetic Neuralgia

Neuralgia is pain that occurs along the path of the nerves. This condition is best known in relation to Shingles(Varicella Zoster Virus).
Although it has been little studied in connection with genital Herpes Simplex infection, the incidence of this condition is much more common that is normally reported.

This type of neuralgia is the result of the virus irritating the nerves and neural pathways. The symptoms are similar to Prodrome,including tingling,twitching, burning sensations, shooting pains, numbness, and/or aches in the area of infection, and also particularly in the buttocks,
legs, and thighs.

The pain can be intermittent, and in some people it can be chronic, lasting for weeks and months at a time. This kind of chronic HSV-PHN is considered to be rare, although anecdotal evidence suggests that it occurs much more frequently than has been
documented. HSV can also cause a "sciatica syndrome" - pain the sciatic nerve in the back of
the thigh. Many women have found their PHN intensifies prior to menstruation.

When PHN is accompanied by frequent outbreaks, some people have found a course of suppressive anti-viral drug therapy to be helpful. There is conflicting advice on the effectiveness of suppressive therapy with acyclovir (Zovirax). Some research indicates that it either has no effect, or that it worsens "unexplained nonlesional HSV episodes." Some people do find that daily suppressive therapy with acyclovir brings them relief from PHN, possibly by decreasing the irritation to the nerves caused by frequent outbreaks.

Acyclovir works by interrupting the new viral replication, and by keeping the virus in check, the nerves are able to calm down and rest after having been irritated for so long. This may take weeks or even months to achieve, depending on various factors, and it's effectiveness appears to increase dramatically by being very regular in the timing of the dosage.

Elavil, as well as certain other tricyclic antidepressant medications, have pain reduction properties that appear to be independent of their antidepressant actions, and have been recommended and used for PHN associated with Shingles. The pain alleviation effect can be reached at doses much smaller than those normally required for the antidepressant value.

Several medical reference books mention these drugs for "post-herpetic neuralgia" specifically. The drugs mentioned as being possibly effective in relieving neurogenic pain are: imipramine(Tofranil), nortriptyline (Aventyl), amitriptyline (Elavil),clomipramine, desipramine, doxepin, and trimipramine. Especially the first three. However, there are many possible side effects to consider when investigating the use of these drugs. Also, if a person is already taking another type of anti-depressant or any other drug, they may have to go off it for quite a while before starting a new one, or they could have serious complications. As always, discuss every aspect of possible treatments and their side effects with your health care provider.

Another treatment that has been shown to be very effective in many cases of neuralgic pain are topical creams containing Capsaicin.
Capsaicin is derived from chile peppers, and works by inhibiting accumulation of "substance P," which sends pain signals from the nerves to the brain. Studies have been done with shingles PHN that have shown Capsaicin's effectiveness. Some people here at HerpeSite prefer "Arthricare Extra Strength Pain Relieving Rub, Odor Free." Another brand that was designed originally and specifially for shingles PHN is "Zostrix"(named after Varicella Zoster Virus, the herpesvirus that
causes chicken pox and shingles!), but Arthricare is much less expensive, and also contains methyl nicotinate (a form of niacin) which dilates the blood vessels under the surface of the skin. The main things to remember if choosing to use one of these creams are: 1) Wash hands immediately after applying, 2) Rub it in gently or it will burn worse than an outbreak, 3)never put it on mucous membranes, 4) heat and warm water will intensify the effects (so no sunbathing, showering, or hot baths afterward!), and 5) Capsaicin's benefits are cumulative, so it may take up to several weeks to achieve full pain-relieving benefits.

Some people have found that eliminating coffee and other neuro-stimulants has helped in both dereasing PHN and outbreaks. There are also some medical experts who say that the neuralgia, like many other aspects of herpesvirus infections, gets better by itself with time...

Experts advise that patients experiencing prodromal symptoms or PHN consider the virus to be active, and to take precautions against transmission.


....BTW imipramine is a nasty drug - we used to use it on the kids at he hospital - however cardiac side effects were noted often - these were potenially life threatening...

Zoloft is a great anti-depressant and would be a good choice as Meg has said - low AE profile - easy to regulate dosage for the neuralgia