10 percent of people with shingles will have residual neuralgia. What is postherpetic neuralgia? It is a pathologic change in the nervous system. About 90% of patients with shingles are really well after the blisters have subsided. However, in about 10% of patients, neuralgia remains after the herpes zoster blisters have subsided. This is because the nerve has not fully recovered after being damaged by the virus. The body has not completely repaired it. So if it doesn’t get our attention, the problem that comes with it is further changes in the spinal cord and the nerves in the brain, which can lead to further nerve damage, and this becomes a refractory pain. ”Why did her shingles go away and mine left behind neuralgia?” Professor Li Jun said that postherpetic neuralgia is a worldwide problem. So far, the only risk factor for which there is definite evidence is over the age of 50. the chance of post-herpetic neuralgia increases significantly in people over the age of 50 who have shingles. the incidence is 8% in the 50-54 age group, rising to 21% in the 80-84 age group. What are its manifestations? It is mainly pain. A patient once described his pain to Professor Li Jun as a “hot and spicy” feeling. In addition, the pain of shingles can be burning, pins and needles, and discharge pain. How to treat post-herpetic neuralgia? 1, prevention is better than cure: early detection and early treatment will make the probability of post-herpetic pain much smaller. Early treatment is mainly through medication. Because the early stage is the active period of the virus, through the antiviral and nerve-nourishing analgesic drugs will have a very good effect. When blistering occurs, it is important to prevent infection of the lesion. It is important to keep the area dry. Treatment with a baked laser can help the lesions heal quickly. Professor Li Jun said that rest is more important, rest is good to improve the immune system. 2. Medication The preferred medications for treating postherpetic neuralgia include gabapentin, pregabalin, antidepressants, and topical lidocaine. Many patients, even doctors who do not understand the treatment of postherpetic neuralgia, will question why antidepressants are used, and patients will say, “I’m not depressed or anxious, why should I take this medicine?” There is a strong resistance to the use of antidepressants. In fact, the use of antidepressants does not mean that the doctor thinks the patient is depressed, but because the neurotransmitters in the pain and emotional neuropathways have something in common, so international treatment guidelines recommend the use of antidepressants to treat neuropathic pain. In addition to this analgesic drugs can be used, some patients believe that the use of analgesic drugs is addictive and try not to use them. However, we advocate actively controlling the patient’s pain, because prolonged pain can cause changes in the neural pathways of the spinal cord and brain, resulting in pain that becomes intractable. At the same time, pain can affect the patient’s diet and sleep, and actively controlling pain can help improve the patient’s overall condition and promote recovery. In addition to this, neurotrophic drugs can be used to promote nerve repair. 3. Nerve block treatment: Why is the needle hitting the back instead of the painful area? This is the special treatment of the pain department for postherpetic neuralgia. This treatment involves injecting local anesthetics, nerve-nourishing drugs and small doses of hormones around the damaged nerve to help the nerve return to its normal state as soon as possible. In the clinic, patients often ask, “Shouldn’t the injection be given in the area where I have pain? Why should I get a shot in the back? This is because the varicella-zoster virus destroys the ganglia, and the nerve block is done by injecting the medication into the area where the nerve is really damaged instead of where the herpes grows. This is the same reason why a polluted river should be treated at its source. Nerve blocks are not only a treatment for postherpetic neuralgia, they are also indicated for the acute phase of shingles. It has been shown that doing nerve block as early as possible in the acute phase of herpes zoster helps to relieve pain and reduce the incidence of postherpetic neuralgia. 4.Nerve radiofrequency treatment Nerve radiofrequency is the puncture of a very fine puncture needle near the nerve or ganglion. Ultrasound-guided puncture or X-ray assisted localization can be used to improve the accuracy and safety of the puncture. Then the radiofrequency treatment instrument is connected, there are two ways: one is pulsed radiofrequency, the maximum temperature of the needle tip is 42 degrees Celsius, the characteristic is not to damage the nerve, but also to regulate the function of the nerve to achieve analgesia. There is another kind of radiofrequency thermal coagulation, the temperature around the tip of the needle can reach about 75 degrees Celsius, to destroy the bad nerve and prevent it from affecting other nerves. 5. Chemical nerve destruction The same purpose as radiofrequency thermal coagulation is to destroy the damaged nerve. Specific nerve-destroying drugs, such as alcohol, adriamycin, and phenol glycerin, are injected around the nerve to destroy the nerve and treat the pain. Numbness may occur in the corresponding area after destruction of the nerve.