Shingles Pain Can Be Avoided By Early Aggressive Treatment Combinations

Each year, an estimated 1 million Americans will develop herpes zoster, a painful viral infection most commonly known as shingles.  The same virus that causes chicken pox, the varicella zoster virus, causes shingles; however, not everyone who had chickenpox will develop shingles. Once the rash of chicken pox resolves, the virus remains in a dormant “sleeping” state in certain nerve cells and then reactivates, causing shingles.  What prompts the virus to “awaken” and cause problems is usually related to some type of stress. The stress may be mental, emotional or physical.

Shingles may occur anywhere on the body, even in the eye. The early symptoms can easily be mistaken for another illness. The first symptom of shingles is a burning pain or tingling and extreme sensitivity in one area of the skin. This may be present for one to three days before a red rash occurs.  There also may be a little fever or headache.  The rash soon turns into groups of blisters that look a lot like chicken pox. Great care must be taken if the blisters involve the eye region because permanent eye damage can result.

The blisters generally last for two to three weeks.  During that time pus may collect in the blisters.  The blisters will then crust over and begin to disappear. Once the shingles rash has healed, you may experience severe pain in the area of the rash as well as beyond that area. This severe pain results from nerve damage and can linger for months or years as a condition called post-herpetic neuralgia (PHN), or after-shingles pain. This problem is of most concern to me because it is avoidable for most patients by early, aggressive treatment.

After having shingles, your chances of developing PHN increase with age. For example, if you are age 50 or older, you have a more than 50 percent chance of developing PHN.  If you are 80 or older, you have an 80 percent chance of developing PHN.  Patients describe PHN pain as burning, itching, aching and sharp and the pain can be constant or it may come and go.

For many PHN sufferers, the most disabling part of the pain is the severe sensitivity, which is called allodynia.  The skin may be unusually sensitive to even the lightest touch, smallest draft or slightest change in temperature.  For some PHN sufferers, normal activity may come to a stop for months or longer. Daily tasks, such as taking a shower, getting dressed in the morning, and brushing your hair may be excruciating.  It is common for  PHN patients to become depressed because of the pain.

This pain can act much like the pain seen in the phantom-limb syndrome. The phantom-limb syndrome was common after an arm or leg amputation. Pain is perceived to be in the leg or arm even years after the limb has been amputated. The brain maintains memory cells that contain pain signals which may last forever without treatment. Early treatment is very important for successful elimination of permanent pain.

The shingles virus is contagious. Shingles can be passed on to others who have not had chicken pox, but they will develop chicken pox, not shingles. Shingles may be passed on to people who suffer certain illnesses and those who have weakened immune systems.

Anti-viral drugs taken by mouth should be prescribed for all cases of shingles. Severe shingles requires early, more aggressive treatment with systemic steroids and sometimes nerve block injections.  Combination treatments are often needed for the more painful shingles.  I often use tricyclic antidepressants like amitriptyline ( Elavil) and anticonvulsants like gabapentin (Neurontin) at adjusted dosages. Most of these medications should be started early, at low doses, then increased slowly to achieve maximum benefit.  Medicines taken within 1 to 3 days of the onset of shingles work best and may stop the progression of shingles completely.

Zostavax, the shingles vaccine made by Merck and licensed by the FDA in May of 2006, will reduce the risk of shingles in adults 60 and over.  Zostavax is given as a single dose by injection.  In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older.

Receiving medical treatment for shingles as soon as possible can lessen the duration and severity of the pain and lower your risk for post-herpetic neuralgia (PHN).  The problem I see most in my office is that patients wait too long to seek treatment, because they do not recognize the pain and rash as shingles until later in its course. Remember, shingles treatment works best when begun immediately. Please get help quickly.

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