Do you know shingles neuralgia? Spring is the season when shingles is more likely to occur, and not only doctors are able to diagnose herpes and severe pain, but many ordinary people also recognize the disease. However, the early stage of herpes zoster neuralgia is not only unknown to the general public, but is also easily misdiagnosed by many medical professionals. I have recently seen many patients with early onset herpes zoster neuralgia who have been referred to many hospitals and departments but have not been effectively treated. How do you determine if you have shingles neuralgia at an early stage? 1. Recognize herpes zoster neuralgia. Herpes zoster neuralgia is the reactivation of the varicella-zoster virus latent in the ganglia of the body under factors such as reduced body resistance (such as the elderly, tumor patients, immunocompromised patients), causing irritating severe pain in the skin along the nerve distribution area of the facial trigeminal nerve distribution area or other parts of the body (such as the upper extremities of the neck and shoulder, chest and back, waist and legs), followed by increased pain and the appearance of bunches or sheets of herpes. With treatment and prolongation of the disease, the blisters crust over and heal (some patients have scar pigmentation), and most patients have pain relief or disappearance. However, a small number of patients (middle-aged and elderly people, mainly those over 60 years old) cannot alleviate or completely disappear, manifesting as unbearable burning, knife-like, stabbing or electric shock-like pain, and most have sensory and nociceptive hypersensitivity, which can cause severe pain even when wearing clothes, blowing in the wind or touching with hands. If the pain lasts for more than 2 (or 3) months, it is called postherpetic neuralgia, and some patients last for life, which is exceptionally painful. 2. Characteristics of early herpes zoster neuralgia. Early herpes zoster neuralgia refers to those whose body has not yet developed a herpes or has only few atypical herpes. The characteristics are as follows: (1) severe pain: pain in the body parts mentioned above appears, especially paroxysmal, intense fire-like, pinprick-like pain, heavy at night affecting sleep; (2) short duration of illness: usually in 2-3 days. (3) Local skin nociceptive hypersensitivity: wind blowing, clothes rubbing the skin can cause severe pain. 3.Early diagnosis and early treatment. If your body appears to have the above characteristics of pain, go to the specialist pain department for the treatment of neuralgia, the pain physician will carefully examine the body according to the pain characteristics, give appropriate treatment and advice, and be able to control the pain as soon as possible. In recent times, I have seen more than a dozen patients with early herpes zoster neuralgia in my outpatient clinic, most of whom were transferred to multiple hospitals and departments within 1-2 days. One of them was a 57-year-old male patient with sudden onset of left lower extremity pain for 1.5 days, who went from the emergency room to four other departments in one day, with no abnormalities in the relevant laboratory tests and MRI of the lumbar spine. He entered the clinic at 4:00 pm on crutches with an unusually painful expression. After receiving the patient, there was no abnormality in the general physical examination, and after carefully inquiring about the characteristics of the pain, it was found to be consistent with neuralgia. The patient was then identified as having herpes zoster neuralgia and was given special analgesics and antiviral antipruritic medication and told to follow up on the second and third days. As a result, the herpes appeared one after another, and the patient was naturally very happy that the pain was quickly controlled and the herpes dried and crusted over after 1 week due to early treatment. Several other cases of herpes zoster neuralgia in the head, face and upper extremities were treated well with early diagnosis and treatment. Herpes zoster neuralgia or post-herpetic neuralgia is a severe and very persistent form of neuralgia. It should be clearly diagnosed, and timely treatment should be emphasized. Effective treatment within 2 months is effective, including antiviral drugs, analgesics, nerve blocks, epidural or intravenous continuous analgesia in severe cases, and most of them can make the pain disappear or be significantly relieved without affecting working life. However, there are a few cases that do not work well or are not effectively treated and turn into postherpetic neuralgia, which often seriously affects the patient’s life and work, and in severe cases, the pain is unbearable and the patient loses confidence in life, often for life. In this case, medications are often ineffective and require a combination of treatments, including a combination of several medications, minimally invasive interventional nerve radiofrequency ablation, and even the implementation of expensive methods such as spinal nerve electrical stimulation to provide relief. Thankfully, effective analgesic medications are now available for herpes zoster neuralgia, which can eliminate the severe pain that patients experience.