The Burning, Searing Pain of Postherpetic Neuralgia

Chris Pasero, MS, RN-BC

Disclosures

December 19, 2012

Neuropathic Pain

The words the patient in this scenario uses to describe his pain ("continuous," "burning," and "searing") indicate that he is experiencing neuropathic pain. Among the many other common descriptors used by patients with neuropathic pain are "sharp," "shooting," "sensitive," "freezing," and "itchy."[6] This patient also describes pain from the nonnoxious stimulus of clothing worn over the affected area. Allodynia is a common feature of many neuropathic pain syndromes.[2,6]

Neuropathic pain results from damage of the peripheral or central nervous system (or both) and is characterized by multiple poorly understood and complex underlying mechanisms.[2] The key to diagnosis and treatment of this patient is his history of recovery from acute herpes zoster infection, which was located in the same thoracic region that is presently painful. Although the exact mechanism underlying the initiation of persistent pain is unknown, it is thought that acute herpes zoster irritates and damages peripheral nerves, resulting in the persistent neuropathic pain syndrome postherpetic neuralgia.[2]

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