Postherpetic neuralgia is best described as pain that follows which condition?

• A. After chickenpox
• B. After herpes simplex infection
• C. After CMV infection
• D. Outbreak of shingles

Answer: (D)

Postherpetic neuralgia is pain that persists after a shingles outbreak. Varicella-zoster virus hides in nerve ganglia after the initial chickenpox infection and can reactivate later as herpes zoster (shingles), producing a painful dermatomal rash. Even after the rash heals, nerve damage and ongoing sensitization can cause ongoing neuropathic pain in the same distribution. This lingering pain, often burning or shooting and may be accompanied by allodynia, is what defines postherpetic neuralgia. It’s more common in older adults and can last months to years. Prevention with antiviral therapy during the shingles episode and vaccination to reduce shingles risk helps, while treatment of the neuralgia itself uses neuropathic pain agents such as gabapentinoids, TCAs, or SNRIs.