Many people have had chickenpox in childhood, but even after recovery, the virus remains dormant in the body’s nerves and can reactivate when immunity wanes, causing herpes zoster—commonly known as “shingles.” A pain medicine specialist warns that shingles pain can be excruciating; if the critical early treatment window is missed, nerve damage may occur, leading to postherpetic neuralgia (PHN). In severe cases, this can evolve into chronic pain that undermines physical and mental health and quality of life, so patients are advised to seek medical care promptly upon suspecting shingles.
VZV Damages Nerves and Triggers Mismatched Pain Signals
Dr. Lee Yuk Ming Sunny, a specialist in pain medicine, explains that both chickenpox and shingles are caused by the varicella-zoster virus (VZV), with chickenpox more common in children. Although chickenpox symptoms gradually resolve, residual VZV persists latent in neural tissues and can reactivate later in life or when immunity declines, producing a rash.
Generally, if shingles patients receive antiviral therapy within the first 72 hours of onset, viral activity can be suppressed and the risk of complications reduced. In practice, however, many patients do not exhibit obvious early signs (such as a red, blistering rash) or do not seek care immediately, thereby missing the opportunity for early treatment.
Dr. Lee Yuk Ming Sunny notes that sensory nerves transmit signals to the brain; when the virus invades these nerves, it can cause “crossed wiring,” sending erroneous signals to the brain. Everyday actions that should not cause pain—such as lightly touching paper, putting on clothes, or even a gentle breeze—can then trigger severe pain, greatly distressing patients and significantly disrupting daily life due to PHN.
PHN Can Impair Sleep and Mood
Dr. Lee Yuk Ming Sunny adds that he has seen elderly patients with PHN whose pain led to chronic insomnia, low mood, social withdrawal, and markedly reduced social activity; another office worker developed neuralgia in the buttock region and could only work while standing due to pain.
Moreover, some patients, in an attempt to relieve pain, turn to unproven “folk remedies” or self-medicate with over-the-counter drugs. This can delay access to evidence-based care; clinically, there have been cases where patients unknowingly used so-called “miracle drugs” containing high-dose steroids, ultimately triggering adverse effects such as diabetic ulcers or even osteonecrosis.
Analgesic Neuropathic Patches: A New Treatment Option
Dr. Lee Yuk Ming Sunny states that once PHN is diagnosed, pain specialists tailor treatment to the individual’s symptoms and impact level, including prescribing oral neuropathic pain medications or, in some cases, specific opioid analgesics. Considering that some patients may not tolerate potential side effects of oral neuropathic agents, doctors can also prescribe anesthetic-containing neuropathic pain patches; applied directly to the shingles-affected area, these gradually provide analgesia.
For severe cases, physicians may perform injections around the spinal nerves or carry out pulsed radiofrequency procedures.
Pain Medicine Specialist: Interview with Dr. Lee Yuk Ming Sunny
