Ayurvedic Treatment for Post Herpetic Neuralgia works in different systems and clears the toxins accumulated in the systems. Postherpetic neuralgia is the most common complication of shingles. The condition affects nerve fibres and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. The chickenpox (herpes zoster) virus causes shingles. The risk of developing postherpetic neuralgia gets more with age, it is manifested mostly in people older than 60. There’s no cure, but treatments can ease symptoms. In most cases, postherpetic neuralgia gets better over time.
Signs & symptoms
It is generally limited to the area of skin where the shingles outbreak first occurred — most commonly in a band around the trunk, usually on one side of the body.
Signs and symptoms might include:
Pain that lasts for more than three months after the shingles rash has been cured. The associated pain is described as burning, sharp and jabbing, or deep & aching.
Sensitivity even to light and soft touch.
People are not able to suffer even the touch of clothing on the affected skin (allodynia).
In rare cases, an itchy feeling or numbness.
Causes
It is a complication after an attack of shingles. Greater risk for postherpetic neuralgia is present if:
- The person is older than 50.
- The pain & rashes associated with shingles are very severe.
- Other illnesses such as diabetes are present.
- The location affected by shingles is the face or torso.
- The antiviral treatment was delayed for more than 72 hours after the appearance of the rash.
Pathophysiology
Varicella-Zoster Virus is a highly contagious DNA virus that remains latent within the sensory ganglia following the resolution of chickenpox, which usually occurs during childhood. During Herpes Zoster, Varicella Zoster Virus is reactivated, travels back along the affected neurons away from the sensory ganglia, and propagates in the epidermis. A hallmark of Herpes Zoster is that it is typically unilateral (i.e., not crossing the midline), and in most cases, only a single dermatome is affected. The erythematous maculopapular Herpes Zoster rash is usually accompanied by pain and dysesthesia. This rash develops into clear vesicles similar to the ones in chickenpox. Then, within around two days, pustules form, which then ulcerate, and finally scab over. Scabs fall off in 2–3 weeks and scarring may occur.
Post Herpetic Neuralgia occurs in the same dermatomes as the Herpes Zoster rash and stems from damage to peripheral and central neurons that may be a by-product of the immune/inflammatory response that accompanied Varicella-Zoster Virus reactivation and migration. When damaged, peripheral and central nerve fibres may develop a lower threshold for action potentials, discharge spontaneously, and exhibit disproportionate responses to stimuli, resulting in peripheral sensitization and pain without painful stimuli (allodynia) Patients with PHN experience three major types of pain: 1) constant pain without a stimulus (often described as burning, aching, or throbbing), 2) intermittent pain without a stimulus (often described as stabbing, shooting, or electric shock-like), and 3) pain brought on by a stimulus but is disproportionate to the stimulus (hyperalgesia) enduring for at least 3 months after healing of the Herpes Zoster-related skin rash. In addition, patients may experience a variety of abnormal sensations (dysesthesias or paraesthesia’s).
Diagnosis
Physical examination
Treatments
No single treatment relieves postherpetic neuralgia for everyone. Mostly, a combination of treatments is needed to reduce the pain.
Lidocaine skin patches – small patches like bandages that contain the topical pain-relieving medication lidocaine. The patches are applied, directly to painful skin to deliver temporary relief.
Capsaicin skin patch – It uses a patch with a numbing medication on the affected area.
Anticonvulsants – Certain anti-seizure medications, including gabapentin and pregabalin, can lessen the pain of postherpetic neuralgia. These medicines have remarkable side effects too.
Antidepressants – Certain antidepressants, such as nortriptyline, amitriptyline, duloxetine and venlafaxine, affect key brain chemicals that play a role in both depression and how the body interprets pain. Antidepressants in lower dosage are used effectively in postherpetic neuralgia
Common side effects of these medications include drowsiness, dry mouth, lightheadedness and weight gain.
Opioid painkillers – in severe cases. It is important to get a prescription because opioids can produce adverse effects like dizziness, drowsiness, confusion and constipation.
Steroid injections
Prognosis
The prognosis is good in most of the cases but they may have to take pain medications for about one to three months. For others, the prognosis is fair to poor if the pain is severe, lasts longer than three months, or markedly reduces their quality of life.
Complications
Chronic pain and associated discomforts like
- Depression
- Fatigue
- Difficulty sleeping
- Lack of appetite
- Difficulty concentrating
Disease & Ayurveda
Visarpa
Nidana
Not mentioned separately.
Causative factors of Sopha can cause the same
Vidaahi food items
Purvaaroopa
Not mentioned.
Samprapti
When the vitiated one, two or three doshas get lodged inside or outside of the body, spread very fast and causes inflammation. In baahyavisarpa, the inflammation affects skin and nerves leading to severe pain and other discomforts.
Lakshana
Sopha – swelling
Sphurana – throbbing
Nistoda – piercing pain
Bheda – stabbing pain
Arthi – severe pain
Harsha – numbness
Divisions
- Vaatika
- Paittika
- Kaphaja
- Baahya
- Aabhyantara
- Baahya-aabhyantara
Prognosis
Krichhrasadhyam- Difficult to manage.
Chikithsa
Treatment of visarpa should start with Langhana (fasting) and Rookshana (drying) therapies. After proper aamapaachana, bloodletting should be done to clean the circulation. After bloodletting, Vamana and virechana are indicated. In cases of Visarpa, snehana (use of oils/fats) therapies are contra indicated.
Samana
Lepanam with Rookshana dravyas
Parisheka with soolahara-rooksha & seethadravyas
Sodhana
Raktamokshanam
Vamanam
Virechanam
Commonly used medicines
Drakshadi kashayam
Guduchyadi kashayam
Naalpaamaradi kwatham
Naalpaamarachoornalepam
Brands available
AVS Kottakal
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Home remedies
Shingles cause severe pain & discomforts which cannot be managed at home. No home remedy is proven to cure shingles. Following herbs may help to lessen the suffering.
Cold compresses
Essential oils
Aloe vera
Witch hazel
Oatmeal
Turmeric paste
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Spicy and hot food items
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Milk and milk products – increase kapha, obstruct channels and obesity
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Gooseberry, pomegranate, grapes etc.
Green gram, soups, food items with cold potency.
Freshly cooked and warm food processed with minimal spices.
Behaviour:
Protect yourself from the hot climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid a sedentary lifestyle.
Yoga
Exercise is not advised in cases with severe pain and discomforts. Regular stretching and mild cardio exercises are advised in mild cases. Also, specific yogacharya including naadisuddhi pranayama, bhujangaasana, pavanamuktasana is recommended.
Regular exercise helps improve the bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Yoga for neuropathy
Pavanamuktasana
Nadisudhi pranayama
Bhujangasana
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles