Homoeopathic medicines for Post-herpetic Neuralgia

Dr Anupama PV

Abstract
Post-herpatic neuralgia is a complication of Herpez zoster infection. It is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. Patients with post herpetic neuralgia report decreased quality of life and interference with activities of daily living .it often occurs in elderly age group and immune-compromised individuals. Homoeopathic management in post herpetic neuralgia is by individualized treatment by matching the collective group of symptom presented by the patient.

Keywords; Post Herpetic Neuralgia, Homoeopathic remedy.

Introduction
Post-herpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster (HZ) rash. Herpes zoster or shingles is a clinical condition caused by varicella zoster virus, after a primary chicken pox infection which remain latent in the body a decades earlier, reactivation of this varicella virus without rashes can also produce neuralgia, which is more challenging to diagnose and may involve testing cerebrospinal fluid.

Epidemiology
It is estimated that 5%–20% of those with HZ go on to develop PHN. Annual incidence among healthy people under the age of 20 years is approximately I per 1000; the incidence is 5 to 10 times greater for those older than 80 years. Intensity of pain and impaired quality of life signifies its clinical importance.

Pathogenesis of pain
Reactivated virus produces inflammatory changes associated with the movement of viral particles from the sensory nerve to skin and subcutaneous tissues, and by damage to nervous structures. Activity of primary afferent neuron that responds to tissue damage causes changes in the dorsal horn neurons, sensitizing them to further input and resulting in spontaneous activity capable for pain in absence of on-going tissue damage.

Types of PHN

1. Acute herpetic neuralgia: neuralgia refers to pain preceding or accompanying the eruption of rash that persist up to 30 days from the onset.
2. Sub-acute herpetic neuralgia pain that persists beyond healing of the rash but resolves within four months of onset.
3. PHN refers to pain persisting beyond four months from the initial onset of rash.

Risk Factors

1. Older age, greater acute pain and greater rash severity.
2. Patients who develop PHN, advanced age is associated with increase in severity and persistence of symptom.

Signs and symptoms
The typical presentation of eruption in herpes zoster is unilateral (not crossing midline) and single dermatome is affected in most of the cases. The erythematous maculopapular herpes-zoster rash is usually accompanied by pain and dysesthesia, rashes progress to clear vesicle similar to original chicken pox outbreak. Scabs fall off in 2- 3 weeks and scarring occur, pain may in presented in the form of constant or intermittent without a stimulus, pain disproportionate to stimulus along with pain patient may experience variety of abnormal sensations (dysesthesias or paresthesias). Patient with PHN report decreased quality of life and interference in daily activity which in turn affects social and mental aspects too.

Diagnosis
Diagnosis is mainly based on history of varicella infection and presentation of source of pain and presentation of pain with hypersensitivity or hyposensitivity  and abnormal sensations .Physical examination for scar marks.

Diagnosis does not rely only on the basis of laboratory investigations, Serological testing for VZV IgG and IgM titers is available, although the sensitivity and specificity are less than ideal. A four-fold rise has been used to diagnose subclinical HZ (zoster sine herpete). However, this rising titer may or may not be secondary to viral exposure or reactivation. Comparatively, immunofluorescence of vesicle scrapings detects VZV antigens in a highly specific and sensitive manner. Similarly, PCR is exquisitely sensitive for the detection of VZV DNA. Results of cerebrospinal fluid (CSF) analysis are abnormal in 61% of patients.

Homoeopathic remedy

Rhus tox:
Vesicular eruptions yellowish, burning sensation, itching aggravation by scratching. Generally patient with marked restlessness .conditions that are accompanied by fever. Tingling sensation.. Most commonly indicated remedy for post herpetic neuralgia.

Arsenicum Album:
Burning pain is very severe at night. Arsenic Album is also given to manage itching on the skin. Restlessness can attend these symptoms. It is also indicated to manage active Herpes zoster outbreak when marked burning pain is felt in the eruptions. These eruptions might be covered with scales like fish scales in most of the cases.

Prunus Spinosa:
Prunus spinosa is a remedy indicated for herpes zoster and neuralgic pain with or following herpes zoster, tightness, stitches and sticking pain in the chest. Aching pain in herpetic region ,stitches on loin to navel, taking away breath aggravation lying on back, pain as from ulceration in loins as if caused by strains. Effective in 30C.

Mezerium:
Action on face, tingling and numbness. Pain in the face may get worse while eating, action is mainly on the facial nerve, burning pain, itching at night, aggravation by warmth.

Hypericum:
Neuritis, with tingling burning, numbness. Sensations of crawling in hands and feet. Violent pain.

Sempervivum Tectorum
Remedy recommended for herpes zoster, soreness of the tongue with stabbing pain, clinically effective in tincture form.

Kalmia Latifolia:
Vesicular yellowish eruptions, exceedingly painful, neuralgia on face, right sided affection, stupefying, numbness in the parts. Tired feeling in masticator muscle. Stitches and tearing in lower jaw. most indicated for neuralgic pain in the face.

Reference

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Dr Anupama PV
MD part 1
Father Muller Homoeopathic Medical College
Mangalore