Postherpetic Neuralgia: When Recovery Is Slow

Greetings from Baengnokdam Korean Medicine Clinic.

"Even after taking medication, the pain doesn't subside..."

An 80-year-old patient, Mr. Park, visited the hospital a few months ago with sudden, severe pain and red blisters on one side of his face. The diagnosis was shingles (herpes zoster). Antiviral and steroid medications were started, and the blisters subsided, but the problem arose afterward. Even after the blisters disappeared, the facial pain persisted. The hospital diagnosed him with Postherpetic Neuralgia (PHN).

Initially, he was prescribed anticonvulsants like Gabapentin (Neurontin) and Pregabalin (Lyrica), along with other medications for pain relief. However, the pain did not significantly improve, and even after he started taking additional anti-inflammatory painkillers from the pharmacy, the effect was still minimal. Seeing no further improvement with conventional drug therapy, Mr. Park visited our Korean medicine clinic. We decided to combine herbal medicine and acupuncture with the goals of restoring immune function, promoting nerve regeneration, and alleviating pain.

What is Postherpetic Neuralgia?

Postherpetic Neuralgia (PHN) refers to a condition where pain persists even after shingles lesions have disappeared from the skin. The shingles virus causes inflammation and damage to the nerves, and even after the skin lesions heal, pain signals continue to be transmitted.

Why does it occur?

• Nerve Damage: The virus directly damages nerve endings and pathways.
• Central Sensitization: Damaged nerves transmit excessive pain signals, and pain responses in the brain and spinal cord can become hypersensitive.
• Persistent Inflammation: Inflammatory responses left by the virus may not subside, leading to chronic pain.

Who is more vulnerable?

• Elderly: Reduced immunity and nerve regeneration capabilities lead to slower recovery.
• Delayed Initial Treatment: If antiviral medication is taken late after the onset of shingles, nerve damage can be more severe.

Conventional Treatments and Their Limitations

The patient was prescribed the following medications at the hospital:

• Gabapentin (Neurontin), Pregabalin (Lyrica): Attempts to relieve pain by suppressing nerve excitation.
• Antidepressants (Amitriptyline, Cymbalta): Reduce pain signals and improve depression and sleep disorders.
• Anti-inflammatory Painkillers (e.g., Ultracet): General pain relief.

However, the patient did not respond sufficiently to the medication. The reasons for this may include:

• Reduced nerve regeneration rate due to old age.
• Drug resistance or individual drug metabolism characteristics.
• The possibility of severe inflammation and nerve damage.

Korean Medicine Approach: Immunity, Nerve Regeneration, Pain Control

We established a treatment plan combining herbal medicine and acupuncture.

1. Herbal Medicine Treatment

Herbal medicine is prescribed according to the patient's constitution, with the following main goals:

• Immune System Restoration: Strengthens the body's natural healing abilities to reduce inflammation left by the virus.
• Promotion of Nerve Regeneration: Herbal medicine includes ingredients that can aid in the recovery of damaged nerves. Typically, herbs that improve blood circulation or suppress inflammation are used.
• Pain Alleviation: Helps regulate pain pathways and calm nerves.

2. Acupuncture Treatment

Acupuncture is gaining attention as an effective alternative treatment for patients with postherpetic neuralgia.

• Analgesic Effect: Acupuncture stimulation reduces hypersensitivity of nerve endings and helps the brain secrete analgesic substances like endorphins.
• Inflammation Suppression: Reduces inflammatory mediators to alleviate pain.
• Nerve Regeneration: Acupuncture can promote the recovery of damaged nerves and improve neuroplasticity.

3. Treatment Process

Acupuncture treatment is combined with herbal medicine intake 2-3 times a week. Initially, the focus is on pain relief and nerve stabilization, followed by a stage of strengthening immunity and nerve regeneration.

Advice for Patients

• Treatment should be customized. Not all patients respond to the same medications or treatments. If conventional treatments are ineffective, as in the case above, exploring new methods through a Korean medicine approach can be a good option.
• Recovery takes time. Consistent treatment is important, especially for elderly patients whose nerve recovery is slow.
• Immune system management is essential. Strengthen your immunity with proper nutrition, light exercise, and sufficient sleep. Preventing shingles recurrence is also important.

Although postherpetic neuralgia can cause long-lasting pain, it can be significantly improved with appropriate treatment and management. Consider seeking help through Korean medicine to reduce pain and restore your quality of life. 😊