Why Do Some People Get Postherpetic Neuralgia And Some Dont
Luckily, a relatively small percentage of shingles sufferers will continue to feel the associated pain long after the rash goes away. The patients who do develop postherpetic neuralgia tend to be over the age of 50, and the rash was located on their face or torso area. Some suffer from diabetes, which also comes with complications that affect the nerves permanently.
If the patient begins taking an antiviral medication within 72 hours from the onset of their shingles rash, they can dramatically reduce the chance of postherpetic neuralgia emerging after theyve healed.
Is Shingles Contagious
Shingles is not contagious but is the reactivation of a virus already present in the body.
However, a person with shingles can give chickenpox to someone who has never had the VZV infection before.
Therefore, people with shingles should avoid contact with those who have never had chickenpox until their rash has completely healed. To catch the virus, someone must have direct contact with the rash.
To avoid spreading VZV, people with shingles should:
- Avoid close contact with people who have never had chickenpox or been vaccinated for chickenpox.
- Avoid close contact with low birth-weight infants and people with a compromised immune system, such as those on HIV medication or who have had an organ transplant.
- Keep the rash covered with loose, natural clothing to avoid others coming into contact with it.
- Wash their hands frequently, especially after touching the rash or applying lotions to the skin.
There is a vaccination available to reduce the risk of developing shingles and experiencing long-term complications, such as PHN.
The recommends that adults aged 50 years and older have two doses of the Shingrex vaccination over a 2-6 month period. It is believed to be more than 90% effective at preventing shingles and PHN.
People who have already had shingles can have the vaccine to prevent future occurrences.
How Is It Treated
It is best to start treatment as soon as possible after you notice the rash. See your healthcare provider to discuss treatment with antiviral medicine, such as acyclovir. This medicine is most effective if you start taking it within the first 3 days of the rash. Antiviral medicine may speed your recovery and lessen the chance that the pain will last for a long time.
Your provider may also recommend or prescribe:
- medicine for pain
- antibacterial salves or lotions to help prevent bacterial infection of the blisters
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Can I Prevent It
The FDA has approved two shingles vaccines, Zostavax and Shingrix. A vaccine is now recommended for everyone 60 and older. People from 50 to 59 may want to talk to their doctor about it if they have ongoing pain or skin issues or have a weakened immune system.
The vaccines cut the chance of shingles by at least 50%. Even if you still get shingles, the painful period is shortened and you reduce your risk of postherpetic neuralgia.
Early treatment for shingles can also lower your chances of getting this complication. So if you think you have it, call your doctor right away. The main treatment is with antiviral drugs during the early stages of shingles, within 2 to 3 days of symptoms coming on. Medications used include:
Is A Vaccine Available To Prevent Shingles
Two vaccines are available in the United States to reduce your chance of developing shingles and postherpetic neuralgia. One vaccine, Zostavax®, has been available since 2006. The second vaccine, Shingrix®, has been available since 2017. Shingrix is recommended as the preferred vaccine by the Advisory Committee on Immunization Practices, a group of medical and public health experts.
Shingrix® is given as a two-dose shot in the upper arm. You should receive the second dose two to six months after receiving the first. Shingrix has been shown to be more than 90% effective in preventing shingles and postherpetic neuralgia. Its effectiveness remains above 85% for at least four years after receiving the vaccine.
Due to high levels of demand for the Shingrix vaccine and a supply shortage, the vaccine manufacturer is managing the timing and distribution of the vaccine throughout the United States. It plans to continue to manage the availability of the vaccine and hopes to make available the same or increased number of doses and to shorten the wait time for delivery this year .
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Who Should Not Be Vaccinated With Shingrix
Shingrix is given by injection into the upper arm. Shingrix is generally well tolerated. In general, Shingrix is not recommended for: People who are allergic to any component of Shingrix. People with a weakened immune system. People who have a weakened immune system because of:
HIV/AIDS, or- cancer treatments
Treating Pain After Shingles
The October issue of Mayo Clinic Health Letter explains this painful and common complication of shingles. Some studies have shown that half of the people 60 years and older who develop shingles experience this complication.
Shingles occurs when the chickenpox virus, present and dormant in those who had chickenpox, becomes reactivated. Age, illness, stress or medications that suppress the immune system can contribute to reactivation. The virus travels along nerve fibers that extend to the skin and typically shows up as a trail of rash and blisters. They most often present as a band around the trunk, usually just on one side. Postherpetic neuralgia occurs if nerve fibers are damaged during the shingles outbreak. The result is excruciating pain that may persist for months or even years after the disappearance of the shingles rash and blisters.
Signs and symptoms of postherpetic neuralgia generally occur in the same area as the shingles outbreak. The pain may be sharp, burning, or deep and aching. Sensitivity to light touch, even the touch of clothing, can be extreme.
There is no single treatment to manage postherpetic neuralgia. Usually, a combination of strategies will be used. They may include:
- Skin patches for topical pain relief
- Anti-seizure medications that stabilize abnormal activity in the nervous system
- Opioids and other pain medications
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Will The Pain Go Away
Without treatment, PHN typically eases gradually and goes. In about 5 in 10 people with PHN, symptoms are gone by three months. However, without treatment, about 3 in 10 people with PHN still have pain after a year. Some people have a slow improvement over a long period of time. A small number of people do not have any improvement over time without any treatment.
How Common Is Postherpetic Neuralgia
Varicella-zoster virus causes both chickenpox and shingles. About 99% of Americans over age 40 have had chickenpox. About one in three people in the U.S. develop shingles in their lifetime. Some 10 to 18% of people who get shingles will develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles.
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Causes Of Shingles Pain
Causes of Shingles Pain
The main cause of shingles pain is a viral infection of the nerve root. If you ever had chickenpox, the virus will remain dormant in your body for the rest of your life. As you grow older, your immune system becomes weaker and suppressed from medications or other procedures such as chemotherapy. When your immune system gets weak, the virus can reactivate, causing shingles pain.
Prevent Shingles With Vaccination
The Centers for Disease Control and Prevention recommends that almost all people ages 60 and older be vaccinated against shingles, whether or not they had chicken pox in their youth or have had shingles before, says Dr. Oaklander.
The vaccination that prevents chickenpox in children was used to develop a similar vaccine that protects against shingles. It reduces the risk of getting shingles by about half, and shingles rashes that still develop are slightly less likely to cause postherpetic pain, or other serious complications, says Dr. Oaklander.
People with especially weak immune systems, such as those with cancer or anyone undergoing immunosuppressive treatments, should avoid Zostavax since the vaccine contains a weakened form of the live virus. Because Zostavax has only been available since 2006, it is still not yet clear if a single vaccination offers lifelong protection, but at this time, no booster is recommended.
A new shingles vaccine called HZ/su also may be helpful for older adults. A study published in The New England Journal of Medicine found that the vaccine was 97.2% effective among those ages 50 and older, and 97.9% effective for those ages 70 and older. And since HZ/su is not made from a live, weakened virus, it is safe to give to people with weak immune systems. This vaccine still needs to undergo further testing before it can be submitted for FDA approval, which may happen as early as this year.
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Preventing Nerve Pain After Shingles
But if you’re worried about PHN, don’t despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: famciclovir , valacyclovir , and acyclovir . These medications need to be started within two to three days of the onset of shingles.
“If you look at the clinical trials with any of these drugs in people over 50,” says Dworkin, “they cut the rate of pain at six months in half. That’s a very significant improvement.” They are also very safe and have few side effects, he says.
But who needs the drugs? Dworkin says there’s not a clear consensus yet.
There are some obvious cases. “I think everyone would agree that someone who is over 50 and has severe symptoms should get preventative treatment,” he tells WebMD.
But for younger people or those with fewer risk factors, the course is less clear.
“Some people think that everyone who gets shingles should get preventative treatment with antiviral medicines, because the medicines are so safe and have such few side effects,” he says.
Others argue that preventative treatment should only be given to those at greater risk. The main reason for this, Dworkin says, is cost.
“A full course of treatment could cost anywhere between $100 and $160,” he says. “That can add up, and insurance companies might not want to pay if the risks are very, very low.”
The Details: Heres Where Postherpetic Neuralgia Gets Complicated
Postherpetic Neuralgia Causes
To help you understand how shingles can cause PHN, you need to know how you can get shingles. Shingles is caused by a viral infection called herpes zoster. The virus that causes herpes zoster is called the varicella-zoster virus, and it is the same virus that causes chicken pox in childhood. After a person recovers from chickenpox, the virus can enter the nervous system and remain dormant for many years. In some people, the virus will reactivate years later and produce shingles.4
Researchers arent exactly sure what triggers the herpes zoster virus to re-emerge after all those years, but they think it is related to age, illness, and stress.3 Shingles can be very painful, and when the virus reaches the skin, it can cause blistery rashes. These rashes usually heal in less than 3 months.
And this chain of events can lead to PHN. If the pain of shingles lingers longer than 3 months, you may have PHN.
During your bout with shingles, the virus you were fighting injured nerves in and around the skin where the rash and blisters once existed. As your immune system eventually suppressed the virus, your rash and blisters disappeared. You may have even felt less pain, and you assumed that you had won the battle with shingles.
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Where Does Shingles Come From
When you have chickenpox as a child, your body fights off the varicella-zoster virus and the physical signs of chickenpox fade away, but the virus always remains in your body. In adulthood, sometimes the virus becomes active again. This time, the varicella-zoster virus makes its second appearance in the form of shingles.
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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.
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Nerve Pain: Most Common Complication Of Shingles
Nerve pain is the most common complication of shingles. The formal name for shingles nerve pain is postherpetic neuralgia . What causes PHN? Nerves damaged by the vaccine-preventable herpes zoster virus.
Pain occurs in the skin that was initially affected by the shingles rash, says Thomas. It can be a mild, lingering pain or an abnormal sensation when touching the skin. For other people, it can be persistent, burning, or shooting pain that can be really disruptive to daily life.
Can You Spread Shingles Over Your Own Body
Shingles cannot be spread over different areas of your body. For example, if you have an active shingles rash on your back, the fluid from the blisters cannot cause a new rash on your arm.
However, the fluid could potentially spread VZV to someone else if theyve never had chickenpox or received the chickenpox vaccine.
One caveat here is that some people can develop disseminated herpes zoster, which is when the shingles virus causes a rash over multiple areas of the body. This can happen in people who have weakened immune systems from autoimmune disease, cancer, or immunosuppressant medications.
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Dont Shrug Off Shingles
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If you had chickenpox as a kid, there is a good chance you may develop shingles later in life. In fact, one in three is predicted to get shingles during their lifetime, says Dr. Anne Louise Oaklander, director of the Nerve Unit at Harvard-affiliated Massachusetts General Hospital.
The same varicella-zoster virus that causes chickenpox also causes shingles. After the telltale spots of chickenpox vanish, the virus lies dormant in your nerve cells near the spinal cord and brain. When your immunity weakens from normal aging or from illnesses or medications, the virus can re-emerge. It then travels along a nerve to trigger a rash in the skin connected to that nerve. The rash often appears on only one side of your body. The most common locations are the chest, back, or stomach, or above one eye.
For Some Pain From Shingles May Linger And Become Long
Dear Mayo Clinic:
I have been diagnosed with shingles of the trigeminal nerve affecting my face. How do I reduce the pain in my head and eye after having shingles?
Answer:For most people, the pain from a case of shingles usually fades as the rash disappears. But for some, the pain may linger and become a long-term condition. A variety of treatments may lessen this pain, but the condition can be challenging to treat.
Shingles is a localized form of chickenpox. Once you’ve had chickenpox, the varicella-zoster virus that caused it remains in your body for the rest of your life. As you grow older, the virus can reactivate. Sometimes this occurs when your body is stressed because of another infection or due to medications that suppress your immune system, for example. The result is shingles. Because you have some immunity against the virus, rather than getting a full body rash, the rash occurs in areas of skin supplied by the nerve where the virus is reactivated.
Shingles typically involves a bandlike rash on the chest, abdomen or face that is usually quite painful. Most people recover from shingles in a few weeks without other problems, but a small number continue to have severe pain in the same distribution that was irritated when the virus returned. Pain that lasts for three months or more is called postherpetic neuralgia.
If medications aren’t enough, procedures such as nerve blocks or steroid injections may help lessen postherpetic neuralgia.
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