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.
Year Five: Chronic Or Recurrent Eye Disease
When shingles impacts the eyes its called herpes zoster ophthalmicus, or HZO. And according to a report in the journal Ophthalmology, 25% of patients experience chronic or recurrent eye disease within five years of HZO. Although most patients with HZO do not experience recurrence, it is important for patients to remain vigilant for recurrences due to potential for long-term damage to their eyes, says Dr. Shekhawat. Recurrent HZO can cause severe dry eye, corneal nerve damage and inflammation and scarring on the inside of the eye, which can damage vision and cause elevation of intraocular pressure leading to glaucoma, says Dr. Shekhawat.
Lasting Pain After Shingles
Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. Its still not clear how it can be prevented or what the best treatment is.
Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word “post-herpetic” means “post-herpes” because the pain arises after infection by the herpes zoster virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.
The main symptom of post-herpetic neuralgia is pain in the nerves . The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.
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Tingling Pain Or Numbness
During the first stage of shingles, before anything appears on your skin, a particular area of your body may begin to feel different. “When a shingles outbreak is starting, you may feel itching, burning, or pain,” Kim says. Often you will feel this on only one side of your body.
The initial signs of shingles may feel different for each person. In some cases, shingles can cause intense sensitivity, making it painful to even wear clothes over your skin, while in other cases, your skin may feel numb.
Shingles Symptoms Before Rash
Shingles develops in two stages. The first is called the prodromal period.
Shingles is a reactivation of the varicella virus, which is what causes chickenpox. After an initial infection, the virus lays dormant in the body. Once reactivated, which can happen years down the line, shingles results.
Often, the earliest signs this is occurring are similar to what you’d expect at the start of any infection. These symptoms sometimes occur at times when you’re feeling stressed or run down. They are also systemic, meaning they affect the whole body.
You may assume you’re just overtired or coming down with a cold when you actually have shingles.
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Treatment For Shingles Pain Including Postherpetic Neuralgia
There is no cure for shingles. However, starting treatment with antiviral drugs early on, can speed the healing process. A pain specialist will treat you if you are experiencing a long lasting type of shingles pain, known as post-herpetic neuralgia. Postherpetic neuralgia is nerve pain. It feels like burning, tingling, or stinging over the area of the outbreak. It may last for weeks or months after the rash has disappeared.
Treatment options:
Week Four: Healing Scabs
Most people with shingles do not develop a blister-related infection. Instead, scabs appear once the blisters dry up and crust over. That typically occurs seven to 10 days post-blistery outbreak, according to the Centers for Disease Control and Prevention. Its important to remember that until scabs appear, your blisters contain the virus, which can cause others to catch the chickenpox. Its also important to continue to wash the area with a fragrance-free cleanser daily until the rash, blisters and scabs are completely clear. Within a month, your skins appearance will most likely return to normal, though some people are left with darker or lighter spots where the shingles rash occurred.
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Preventing The Virus Spreading
If you have the shingles rash, do not share towels or flannels, go swimming, or play contact sports. This will help prevent the virus being passed on to someone who has not had chickenpox.
You should also avoid work or school if your rash is weeping and cannot be covered.
Chickenpox can be particularly dangerous for certain groups of people. If you have shingles, avoid:
- women who are pregnant and have not had chickenpox before as they could catch it from you, which may harm their unborn baby
- people who have a weak immune system, such as someone with HIV or AIDS
- babies less than one month old, unless it is your own baby, in which case your baby should have antibodies to protect them from the virus
Once your blisters have dried and scabbed over, you are no longer contagious and will not need to avoid anyone.
How Is Shingles Treated
Specific treatment for shingles will be determined by your healthcare provider based on:
- Your age, overall health, and medical history
- How long the shingles have been present
- Extent of the condition
- Your tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
There is no cure for shingles. It simply has to run its course. Treatment focuses on pain relief. Painkillers may help relieve some of the pain. Antiviral drugs may help lessen some of the symptoms and reduce nerve damage. Other treatments may include:
- Creams or lotions to help relieve itching
- Cool compresses applied to affected skin areas
- Antiviral medicines
- Anticonvulsants
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Questions To Ask Your Doctor
- Ive had chickenpox. Am I at risk of developing shingles?
- What is the best treatment for my shingles?
- The pain from shingles isnt going away. What can I do to make myself more comfortable?
- Im on treatment for shingles. When should I call my doctor if things dont get better?
- I have shingles and my children havent had the chickenpox vaccine. Should I get them vaccinated?
- Is the shingles vaccine right for me?
- Are there any risks associated with the shingles vaccine?
- Will my post-herpetic neuralgia ever go away?
- If Ive never had the chickenpox, should I still get the shingles vaccination?
How Is Shingles Diagnosed And Treated
If you think you might have shingles, talk to your doctor as soon as possible. Its important to see your doctor no later than three days after the rash starts. The doctor will confirm whether you have shingles and can make a treatment plan. Most cases can be diagnosed from a visual examination. If you have a condition that weakens the immune system, your doctor may order a shingles test. Although there is no cure for shingles, early treatment with antiviral medications can help the blisters clear up faster and limit severe pain. Shingles can often be treated at home.
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Key Points About Shingles
- Shingles is a common viral infection of the nerves. It causes a painful rash or small blisters on an area of skin.
- Shingles is caused when the chickenpox virus is reactivated.
- It is more common in people with weakened immune systems, and in people over the age of 50.
- Shingles starts with skin sensitivity, tingling, itching, and/or pain followed by rash that looks like small, red spots that turn into blisters.
- The rash is typically affects just one area on one side of the body or face.
- Treatment that is started as soon as possible helps reduce the severity of the disease.
Urgent Advice: Get Advice From 111 As Soon As You Suspect Shingles
You might need medicine to help speed up your recovery and avoid longer-lasting problems.
This works best if taken within 3 days of your symptoms starting.
111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.
Go to 111.nhs.uk or .
Get an urgent GP appointment
A GP may be able to treat you.
Ask your GP surgery for an urgent appointment.
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Stay Away From Certain Groups Of People If You Have Shingles
You cannot spread shingles to others. But people who have not had chickenpox before could catch chickenpox from you.
This is because shingles is caused by the chickenpox virus.
Try to avoid:
- pregnant people who have not had chickenpox before
- people with a weakened immune system like someone having chemotherapy
- babies less than 1 month old unless you gave birth to them, as your baby should be protected from the virus by your immune system
See A Pain Management Specialist
Sometimes the nerve pain is just too intense to manage on your own. If youre experiencing moderate to severe shingles pain, see a pain management specialist for treatment options to help you stay comfortable while you heal.
If youre suffering from shingles related pain and nerve damage, we can help. For more information, contact Republic Spine and Pain to schedule an appointment at one of our locations in Austin, Georgetown, or Lakeway, Texas.
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What Shingles Symptoms Come Next
After about 1 to 5 days, a shingles rash will appear on one side of the body, often in a single characteristic band around one side of the torso or face.
The painful rash will then form itchy or burning blister-like sores filled with a clear fluid. The blisters will scab over in 7 to 10 days. Theyll gradually grow smaller before disappearing.
Shingles rash symptoms commonly last between 2 to 4 weeks.
Are Shingles Always Painful
By Will Sowards
Many people associate discomfort, pain and fatigue with shingles. While its true that most, if not all, symptoms of shingles are uncomfortable, is it safe to say that shingles always cause pain?
The answer to this question is relative and largely based on the infected persons tolerance for pain. Analyzing the symptoms of shingles and how most people respond to them can help us accurately assess whether shingles are always painful.
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How Long Will The Effects Last
The rash from shingles will heal in 1 to 3 weeks and the pain or irritation will usually go away in 3 to 5 weeks. When shingles occurs on the head or scalp, the symptoms usually go away eventually, but it may take many months.
If the virus damages a nerve, you may have pain, numbness, or tingling for months or even years after the rash is healed. This is called postherpetic neuralgia. This chronic condition is most likely to occur after a shingles outbreak in people over 50 years old. Taking antiviral medicine as soon as the shingles is diagnosed may help prevent this problem.
Can Shingles Be Prevented Or Avoided
The best way to prevent shingles is through vaccination. Vaccinate your children for chickenpox. This vaccine reduces their risk for getting chickenpox. You cant get shingles unless youve had chickenpox first.
When you are older, get the shingles vaccine. It is recommended for adults 50 years of age and older. It can prevent shingles. People who have had shingles should get the vaccine to help stop the disease from reoccurring. Common side effects of the vaccine are headache, plus redness, swelling, itching, and soreness at the injection site.
The shingles vaccine is not recommended for anyone who:
- Has had an allergic reaction to gelatin or the antibiotic neomycin
- Has an allergy to any component of the shingles vaccine
- Has a weakened immune system due to conditions such as leukemia, HIV, or AIDS
- Is receiving treatment for cancer
- Is being treated with drugs that suppress their immune system, including high-dose steroids
- Is pregnant or might become pregnant within 4 weeks of getting the vaccine
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How To Treat And Prevent Shingles
Shingles is treated using antiviral medications, such as:
To manage shingles pain, you can also use numbing creams like lidocaine, or place a cool, wet washcloth on your skin.
It’s important to get treatment as quickly as possible because, “people with shingles can develop long-term pain or itch after the shingles resolves if the virus does too much damage,” Kim says.
To stop yourself from spreading varicella-zoster to anyone else, try to cover up your rash when possible and avoid directly touching it.
The best way to prevent shingles is to get a shingles vaccine. The newest vaccine, called Shingrix, is 85% to 90% effective at preventing shingles in people who have already had chickenpox. If you have never had chickenpox, you will need to get the chickenpox vaccine instead.
Factors That Lead To A Shingles Outbreak
Factors that increase your risk of having shingles include:
- A chickenpox outbreak in your childhood Older adults in the United States may have had a full-blown chickenpox infection when they were children. In recent years, due to routine childhood vaccinations, childhood chickenpox outbreaks are less and less common.
- Advanced age Shingles is most common in people older than 50, due to a weakened immune system. Some experts estimate that half the people age 80 and older will have shingles.
- Having certain diseases Diseases that weaken your immune system, such as HIV/AIDS and cancer, can increase the risk for shingles.
- Cancer treatments Radiation or chemotherapy can lower your resistance to diseases and trigger shingles.
- Certain medications Drugs taken in order to prevent rejection of transplanted organs can increase your risk of shingles. Prolonged use of steroids, such as prednisone, can lead to shingles.
For more information on shingles, .
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Have Shingles Get Treatment Take Action
If you have shingles, its important to talk to your doctor about your risk for developing PHN. Ask whether preventative treatment with antiviral drugs makes sense. If your doctor says its not necessary, ask why.
The full implications of the psychological risk factors for PHN arent clear yet, says Dworkin. But he suggests that people with shingles should try to stay active and connected.
If psychological distress is a risk factor for PHN, he says, then we think that people who have shingles might benefit from getting out and not being isolated and homebound.
You might make an effort to stay connected to family and friends and not to dwell on your symptoms. Also, keep in mind that even if you do develop PHN, there are treatments that can help.
We have about a half dozen types of drugs that are used as first-line treatments for PHN, says Dworkin. They include lidocaine patch , pregabalin , gabapentin , capsaicin , carbamazepine , tricyclic antidepressants, and painkillers.
The most important thing is to get prompt medical attention if you think you might have shingles.
If you have a one-sided rash especially if youre over 50 see your doctor right away, says Dworkin. It could be shingles. And we know that prompt treatment can dramatically reduce the likelihood of developing long-term pain.
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Facial Pain And Eye Damage
Between 10% and 15% of the time, shingles affects the trigeminal gangliona triple-branched nerve that provides sensation to structures in the face. The medical term for head or facial pain due to shingles is “painful trigeminal neuropathy attributed to herpes zoster.”
Specifically, the trigeminal ganglion involves the eye the cheek and the mandibular branch . Of these, the ophthalmic branch is the one most commonly affected by herpes zoster.
According to the American Academy of Ophthalmology , 25% of the 300,000 to 500,000 cases of shingles that occur each year are herpes zoster ophthalmicus .
HZO can affect any part of the eye, from the optic nerve to the conjunctiva . Without antiviral treatment, almost half of people who have shingles near the eye will experience eye damage or even lose an eye, so it’s vital to see an ophthalmologist immediately.
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