New Drug For Lingering Shingles Pain
FDA Approves Qutenza for Postherpetic Neuralgia
Nov. 17, 2009 The FDA has approved a new treatment for postherpetic neuralgia , the nerve pain that sometimes lingers after an attack of shingles.
The new PHN drug is Qutenza. Its made by Lohmann Therapie-Systems AD of Andernach, Germany, and distributed by NeurogesX Inc. of San Mateo, Calif.
PHN is excruciating, and is often described as a burning, stabbing, or gnawing pain. It starts with an attack of shingles, in which the herpes zoster virus the chickenpox virus, lying dormant at nerve roots reactivates.
PHN is pain that persists after the shingles scales heal. It affects 10% to 15% of people who have shingles. It may get better over time. It may not. Treatments include prescription pain medications, anticonvulsants, and antidepressants.
Now theres Qutenza, a radically different approach. The active ingredient in Qutenza is synthetic capsaicin, the chemical that makes chili peppers burn. There are over-the-counter capsaicin products, but the FDA notes in a news release that Qutenza is the first pure, concentrated, synthetic capasaicin-containing prescription drug to undergo FDA review.
The product can provide effective pain relief for patients who suffer from PHN, Bob Rappaport, MD, FDA director of Anesthesia, Analgesia, and Rheumatology Products, said in a news release.
Patients may receive an opioid pain drug before or after treatment.
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Sciatic Nerve Glide Exercise
This seated exercise can alleviate sciatica symptoms. You can use this exercise to help your sciatic nerve relax and desensitize.
Follow these steps to complete this exercise:
- Keep your other foot flat on the floor as you sit upright in a chair.
- Bring your toes towards you while slowly bending your ankle.
- Keep bending your ankle backward and forward, pointing your toes away from yourself and then towards your body.
- When the first stretch is tolerated, you can also do the nerve glide while bending your head forward and bringing your chin towards your chest.
- Repeat the exercise 15 to 20 times with one leg, and then with the other.
- Make sure to do three rounds a day for each leg.
Its worth noting that while home remedies like stretches for sciatica pain can help reduce sciatic nerve pain, but they dont fix the underlying cause. A thorough chiropractic review pinpoints the cause of the discomfort, offers medication to alleviate sciatica symptoms, and creates a personalized treatment plan to ensure you stay pain-free for the long haul.
Sciatic nerve pain can be so excruciating and debilitating that you dont even want to get off the couch. Reclining pigeon pose is a common yoga pose that works to open the hips. Sit on the floor with your legs stretched out straight in front of you, standing hamstring stretch. Standing hamstring stretch is a great way to stretch the hamstring muscles. Sciatica pain is triggered when vertebrae in the spine compress.
How To Use Valtrex
Read the Patient Information Leaflet if available from your pharmacist before you start taking valacyclovir and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take valacyclovir by mouth, with or without food, as directed by your doctor. Drink plenty of fluids while taking this medication to lower the chance of side effects.
The dosage and length of treatment are based on your type of infection, medical condition, and response to treatment. For treating chickenpox in children, the dosage is also based on weight.
This medication works best when started at the first sign of an outbreak, as directed by your doctor. It may not work as well if you delay treatment. For shingles or chickenpox, start taking valacyclovir at the first symptom or as soon as possible after the rash appears. For cold sores or genital herpes, start taking this medication at the first sign or as soon as you feel tingling, itching, or burning.
Valacyclovir works best when the amount of medicine in your body is kept at a constant level. Take this drug at evenly spaced intervals. To help you remember, take it at the same time each day.
Continue to take this medication until the full prescribed amount is finished. Do not change your dose, skip any doses, or stop this medication early without your doctor’s approval.
Tell your doctor if your condition persists or worsens.
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Are There Alternative Treatments
Some studies show that various alternative treatments, from acupuncture to supplements, can offer relief. The research isnât complete, but some shows promise. Check with your doctor before you try any of these:
TENS . This therapy uses tiny electrical pulses to relieve pain. A TENS unit is about the size of a smartphone and comes with small patches called electrodes. You put them over the painful area and turn the unit on and off as your pain comes and goes.
Traditional Chinese medicine: These treatments aim to restore balance in your body. They include acupuncture, the ancient practice of inserting very thin needles into your skin at specific points. Also, moxibustion and cupping, two types of heat therapy, are supposed to draw out toxins. These treatments may be done in combination.
Creams and other skin treatments: A mixture of liquid dimethyl sulfoxide and idoxuridine, an antiviral drug, may reduce swelling and the number of blisters you have when you put it on your rash. And chlorophyll, the chemical that gives plants their green color, is also used directly on the rash as a cream or saline solution.
Supplements: Youâll find a long list of herbs, pills, and oils that claim to relieve shingles. Most have no research to back them up, but there are a couple of exceptions. Papain, a protein found in papayas, is sold in capsules. And manuka and clover honeys can be put directly on your skin. Very early studies on both show they may be helpful.
Treating The Pain Of Phn
Exactly how best to deal with the pain is a difficult question. Rice led a research team that looked at 35 clinical trials of various treatments. The findings appear in the July issue of the free-access online journal PloS Medicine.
“The most important thing to realize is these are painkillers,” Rice says. “You are treating the pain, not the disease itself. And this is due to permanent nerve damage. It is like a stroke. We can’t make the nerve damage better, but we can treat the disability. And for PHN, pain is one of those disabilities.”
What helps? Rice’s team found good evidence supporting:
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Topical Pain Relief Products
e.g. lidocaine preparations , capsaicin cream
- topical pain relievers can be used in addition to oral pain relief medicines
- lidocaine is a local anaesthetic and numbs the skin
- do not apply lidocaine to broken or irritated skin avoid contact with eyes
- capsaicin cream should NOT be used on active shingles and may only be used to help with post-herpetic neuralgia . It should be discontinued if symptoms persist for longer than 2 weeks
- do not apply capsaicin cream to broken or irritated skin avoid contact with eyes
Best Treatments For Lasting Shingles Pain
Postherpetic Neuralgia Pain: What Works, What Doesn’t
Doctors call it postherpetic neuralgia or PHN. It’s caused by nerve damage left behind by a case of shingles. Shingles itself comes from reactivation of a chickenpox virus, varicella zoster. The virus travels down nerve fibers to cause a painful skin rash.
When the rash goes away, the pain usually goes with it. But for 12% to 15% of people the pain remains. If your shingles pain lasts eight to 12 weeks after the rash goes away, you’re part of an “unfortunate minority,” says pain researcher Andrew S.C. Rice, MD, of Imperial College, London.
“Among people with PHN, some have their pain resolve in the first year to 18 months after the shingles rash goes away,” Rice tells WebMD. “But if they have pain longer than that, it is not going to go away on its own. In either case, a person must deal with the pain.”
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How Do Dermatologists Treat Shingles
An antiviral medication can:
-
Reduce the amount of time that you have a shingles rash
-
Lower your risk of developing long-lasting nerve pain and other health problems
One of three antiviral medications is usually prescribedacyclovir, famciclovir, or valacyclovir.
To treat your symptoms, dermatologists typically recommend the following:
Pain: Medication that you can buy without a prescription can help, such as:
If you have severe pain, your dermatologist may prescribe a medication that reduces inflammation, such as a corticosteroid.
How To Treat Nerve Pain Caused By Shingles
This article was medically reviewed by Luba Lee, FNP-BC, MS. Luba Lee, FNP-BC is a board certified Family Nurse Practitioner and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support , Emergency Medicine, Advanced Cardiac Life Support , Team Building, and Critical Care Nursing. She received her Master of Science in Nursing from the University of Tennessee in 2006.There are 31 references cited in this article, which can be found at the bottom of the page.wikiHow marks an article as reader-approved once it receives enough positive feedback. In this case, 84% of readers who voted found the article helpful, earning it our reader-approved status. This article has been viewed 88,320 times.
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What Does Prednisone Do
Prednisone, like other corticosteroids, quickly lowers inflammation, which cuts down on pain, redness, and swelling. It also dials down your immune system. Under normal conditions, this system protects you against things like viruses and bacteria that cause infections and diseases.
Sometimes your immune system overreacts and attacks your bodys tissues. Prednisone stops that attack. Thereâs also proof that low-dose prednisone may slow joint damage in people with rheumatoid arthritis, but not as much as other arthritis medications do. It can also cause unpleasant long-term side effects.
Topical Cbd Oil Balm: The Best Delivery Method For Help With Shingle Pain
Applying CBD oil balms, salves, and creams can have a big impact on the rash itself. CBD oil for shooting nerve pain from shingles has been proclaimed an excellent fit. The topical application of CBD can have a great impact on the nerve issues associated with the pain. Though not confirmed scientifically yet, it is speculated that CBD oil both orally and topically can reduce the duration of the virus, while also making you more comfortable as it runs its course.
An intensive topical cream is most likely the best course of action when using a salve or balm for treatment. It is important that you only put it on clean dry skin in order to prevent bacteria from growing on this sensitive rash. There are many topicals out there, so be sure you find one with all-natural ingredients from a trusted source. It can be put on targeted nerve pain areas and might even work instantly to relieve pain.
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How To Use Famciclovir
Read the Patient Information Leaflet if available from your pharmacist before you start taking famciclovir and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food, usually 2 to 3 times a day or as directed by your doctor.
This medication works best when started at the first sign of an outbreak, as directed by your doctor. It may not work as well if you delay treatment.
The dosage is based on your medical condition and response to treatment.
This medication works best when the amount of drug in your body is kept at a constant level. Take this drug at evenly spaced intervals. To help you remember, take it at the same times each day.
Continue to take this medication until the full prescribed amount is finished. Do not change your dose, skip any doses, or stop this medication early without your doctor’s approval.
Tell your doctor if your condition persists or worsens.
Treatment For Lingering Shingles Pain
Most cases of shingles clear up within a month or so. After you have shingles, its unlikely that youll get it again. But as we mentioned above, some people develop PHN, a complication that follows shingles. Older people, women, and those who had more severe shingles symptoms seem to be at higher risk of developing PHN, but its not clear why others never develop it.
Nerve blocks are injections containing local anesthetic to numb nerves contributing to PHN pain. Other minimally invasive treatments include nerve ablation and steroid injections to treat inflammation related to shingles.
We offer several nonaddictive prescription medications for nerve pain. Oral antidepressants or membrane stabilizers can reduce symptoms of PHN. For some people, topical medication like capsaicin cream can temporarily relieve pain.
You dont have to turn to addictive opioid pain medications if you have shingles pain. Dr. Soin and our team are here to help you find relief with a personalized treatment plan, whether its nerve-blocking injections or medication.
If you still have nerve pain after shingles, you dont have to suffer in silence. in Centerville or Beavercreek, Ohio, or book an appointment online to learn more about the PHN treatment that could be right for you.
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Causes And Risk Factors Of Shingles
Other factors increasing the risk of contracting Shingles include people who: Shingles can affect anyone, but the chances of contracting Shingles increase based upon whether the patient had previously contracted chickenpox, or if they had never received the varicella vaccine. Shingles itself contagious, especially if the contact is with someone who has never had chickenpox or the varicella vaccine, although in that case, the person would more likely develop chickenpox than shingles.
- Are over the age of 60
- Have lowered immune-response due to medication or disease
- Contracted chickenpox as an infant
- Have increased stress
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How Is Shingles Diagnosed
See your doctor as soon as you think you may have shingles. This should be within 3 days of the rash first appearing for antiviral medication to be most effective in reducing the risk of complications. The earlier that antiviral medication is given, the more effective it is but it can be given up to 7 days after the rash appears. If it is a holiday period, go to an afterhours clinic. It is particularly important to seek medical advice if your rash is by your eyes or if you are immunosuppressed . To diagnose shingles, your doctor will ask you about your symptoms and will also do an examination. Some people may have pain with no rash or rash with no pain. In such cases, a blood test may be needed to confirm the diagnosis.
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How Can Nerve Blocks Alleviate Shingles Pain
Non-surgical nerve blocks act by stopping the nerves from sending pain signals to the brain. They donât treat the underlying causes of shingles but they do help ease the pain and even prevent PHN before it occurs, by numbing the affected area.
Nerve blocks are a safe shingles pain treatment option. It allows patients to go back to their normal life and to the activities that they enjoy.
How To Identify The Source Of Your Foot Pain
With all the possible causes of nerve pain in the foot, it may be difficult to pinpoint the exact underlying cause. Here are a few useful signs to help you identify the source of your foot pain:
- Foot pain that follows recent trauma to the lower back, hip, knee, or ankle may help indicate the site of nerve damage
- Foot pain due to nerve root compression or sciatica may also be associated with other symptoms, such as pain, numbness, and/or weakness in the buttock, thigh, and leg and typically affects one leg at a time
- Foot pain that develops after wearing tight boots or shoes may indicate peroneal or sural nerve compression near the knee or ankle
- Foot pain that develops after a hip injection or hip surgery may indicate sciatic neuropathy
Nerve pain in the foot may also occur due to nerve damage from systemic conditions, such as diabetes or multiple sclerosis.
Twisting, bending, or a direct hit on your ankle and/or foot may injure the foot bones, ankle joint, blood vessels, muscles, and/or tendons, causing foot pain.
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Shingles And Nerve Paths
Shingles is caused by a reactivation of the virus that causes chickenpox. Only people whove had chickenpox or chickenpox vaccines can develop shingles. Having a chickenpox vaccine can lead to shingles because the vaccine contains the virus that causes chickenpox.
Shingles isnt contagious, but people who have not had chickenpox can develop chickenpox if they come in contact with open blisters of somebody with shingles.
After your body fights off a chickenpox infection, the herpes zoster virus remains dormant in your cranial nerves and spinal ganglia until it becomes reactivated. Spinal ganglia are nerve cells that connect your spinal cord to nerves in your body and limbs.
The virus reactivates when your immune system is no longer able to suppress it. Reactivation most commonly occurs in older adults because the immune system tends to get weaker with age, as well as in people with suppressed immune systems.
Once the virus is active, it usually spreads down sensory nerve fibers that lead from your spinal cord to your skin. These nerves carry sensory information like feelings of pain, itchiness, or pressure from your skin to your spinal cord and brain.
Once the virus gets to the end of these sensory nerves, it reaches your skin and usually leads to a rash. This rash often shows up in one or two nearby areas of skin called dermatomes.
A dermatome is an area of your skin where the sensation is supplied by one spinal nerve.