Shingles/Post Herpetic Neuralgia

    
      Re: Shingles/Post Herpetic Neuralgia
    


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Posted by CCF Neuro MD *!* on November 30, 1997 at 18:39:38:

In Reply to: Shingles/Post Herpetic Neuralgia posted by Mary Fitzhugh on November 22, 1997 at 19:03:06:

: I was recently diagnosed with Post Herpetic Neuralgia after having had
  Shingles.   I'm having a problem with the diagnosis for the following
  reason.   When I had Shingles, the skin lessions were located on the back
  and extended to the stomach area on the left side.   At the time that
  I visited my Internist I was also having pain in the left arm,
  but no lesions were visible in that location.   Shortly after taking
  pain medication, the arm pain subsided while the severe nerve pain
  in the back continued for approximately 4 weeks at which time the skin
  lesions also faded. Subsequently, the arm pain returned (still absent
  lesions) and has been constant ever since for a period of nearly
  2 months.  This pain is quite different from the pain during the Shingles
  attack.  The pain is in the upper arm, occasionally throbs, but the main
  problem is attempting to lift the arm, extend it, and is particularly
  excrutiating when attempting to reach behind me.  It is very painful just
  trying to get dressed.  The internist ordered an x-ray to see if there was anything
  else going on, and it showed nothing.
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The report of pain in an area which is not affected by the herpetic rash, would make the diagnosis of Post herpetic neuralgia very difficult, although not absolutely impossible. There are reports of involvement of a nerve root in the infection without any manifestation of vesicles on the skin. If this sort of infection was followed by post herpetic neuralgia it could possibly explain the symptoms.
A strong possibility is that you have a separate process involving the left arm involving one of the high cervical vertebrae C5 or C6.
A problem in this area would be difficult to see on a straightforward X ray and would require an MRI of the cervical spine to visualize it correctly. Another test which could possibly be appropriate in  this case would be an EMG, which studies nerve function and may be able to trace the problem to an individual nerve root, it can sometimes give an idea as to the type of underlying nerve problem which would help to decide if it is due to PHN or not.
If your problems persist it sounds like it is time to see a neurologist in order to have a definite diagnosis,with whatever tests are necessary  prove it, and then initiate appropriate therapy.
This information is provided for general medical education purposes only.
Please consult your physician for diagnostic and treatment options of your specific medical condition.
  Is it possible to have PHN in a location other than where the original
  Shingles occurred?   Should I be seeing a Neurologist?