Burning, electric shock, slashing, stabbing, tearing pain, if you have ever been kissed by this fancy variety of pain that keeps you up at night, then you must come to know postherpetic neuralgia! 1. What is postherpetic neuralgia? Postherpetic neuralgia (PHN), or PHN for short, is pain that persists for 1 month or more after the herpes zoster rash has healed and is the most common complication of shingles. The incidence of PHN in patients with herpes zoster is about 9% to 34%. PHN is a typical neuropathic pain and its incidence increases with age, with PHN occurring in about 65% of patients with herpes zoster aged 60 years and older, and up to 75% of those aged 70 years and older. 2. Why does neuralgia occur in cutaneous shingles? Shingles on the skin is caused by the herpes zoster virus. The herpes zoster virus can cause two types of damage: first, skin damage, i.e. herpes; second, nerve damage, leading to the appearance of various types of neuralgia. 3. How is the clinical presentation different from other pain disorders? PHN pain site: commonly located in unilateral chest, trigeminal nerve (mainly eye branch) or neck, the pain site of PHN is usually enlarged than the herpes area, very few patients will occur bilateral herpes. PHN pain nature: there are burning-like pain, electric shock-like pain, knife-like pain, needle-like pain, tearing-like pain, pain nature is diverse, can be one kind of pain mainly, but also a variety of pain coexist. PHN pain Characteristics: There is spontaneous pain in the rash distribution area and nearby areas, pain hypersensitivity with enhanced or prolonged pain response, and nociceptive hypersensitivity with pain induced by light touch or small changes in temperature such as contact with clothes and bed sheets. 4.How to treat? The most commonly used first-line drugs are calcium channel modulators, such as gabapentin and pregabalin; also tricyclic antidepressants amitriptyline; and topical patches lidocaine patches. In case of poor control of first-line drugs, second-line drugs such as tramadol and opioid analgesics can be used in combination. Physiotherapy, such as neurointerventional techniques and neuromodulation techniques, can also be used when medications are not effective.