What Are The Symptoms
The first sign of shingles is often burning, sharp pain, tingling, or numbness in your skin on one side of your body or face. The most common site is the back or upper abdomen. You may have severe itching or aching. You also may feel tired and ill with fever, chills, headache, and upset stomach or belly pain.
One to 14 days after you start feeling pain, you will notice a rash of small blisters on reddened skin. Within a few days after they appear, the blisters will turn yellow, then dry and crust over. Over the next 2 weeks the crusts drop off, and the skin continues to heal over the next several days to weeks.
Because shingles usually follows nerve paths, the blisters are usually found in a line, often extending from the back or side around to the belly. The blisters are almost always on just one side of the body. Shingles usually doesn’t cross the midline of the body. The rash also may appear on one side of your face or scalp. The painful rash may be in the area of your ear or eye. When shingles occurs on the head or scalp, symptoms can include headaches and weakness of one side of the face, which causes that side of the face to look droopy. The symptoms usually go away eventually, but it may take many months.
In some cases the pain can last for weeks, months, or years, long after the rash heals. This is called postherpetic neuralgia.
Can You End Up In Hospital With Sciatica
Sciatic nerve pain can range from mild to severe, and flare-ups can be painful and intense, requiring immediate medical attention while each case is unique, most people seek medical attention from the hospitals Emergency Department, where they are given immediate pain relief.
The Different Types Of Sciatica And How To Treat Them
Help Is Available For Phn
Fortunately,early treatment for shingles can lower your chances of getting PHN.
For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.
Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.
However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.
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The Basics Of Shingles And Postherpetic Neuralgia
Although anyone can get chickenpox, its more common in children and teens, especially those who havent received the chickenpox vaccine. Unfortunately, even after chickenpox is over, the varicella-zoster virus that caused the condition can remain dormant in the body for decades, emerging later in life as shingles. If the episode of shingles damages nerve tissue, this can result in postherpetic neuralgia.
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
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Is It Possible To Avoid Shingles
Most people get shingles only once, but it is possible to get it two or more times.
Anyone who has had chickenpox can get shingles later in life. There is a shingles vaccine that may help prevent shingles, or make it less painful. The vaccine is recommended for adults ages 60 and older, even if theyve previous had shingles.
For children and adults who never had chickenpox, there is a vaccine that can help avoid getting the virus that causes both chickenpox and shingles.
For anyone who has never had chickenpox and has not received the chickenpox vaccine, it is best to avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious and can cause chickenpox, but not shingles.
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.
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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.
What You Can Do About Nerve Pain That Lingers After Shingles
Chronic pain that continues after a case of shingles is called postherpetic neuralgia . It is estimated that about 20% of patients will experience this type of nerve pain as a complication of shingles.
Those who have had chickenpox are at risk of developing shingles later in life. People who develop PHN are generally age 60 and older. Although there is no cure for PHN, there are several methods of pain management that can ease symptoms. Fortunately, the type of pain that arises from postherpetic neuralgia improves over time.
Neuralgia affects the nerves, causing structural and functional damage. It can feel like a stabbing or burning pain that radiates along the affected nerve.
Neuropathic pain is not caused by an external injury or stimuli but originates from inside the nervous system. When the herpes-varicella zoster virus is reactivated in the form of shingles, scar tissue forms alongside nerves, creating pressure, and sending pain signals to the brain.
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Who Is At Risk Of Getting Postherpetic Neuralgia
Factors that increase the risk of developing postherpetic neuralgia include:
- Older age: The chance of developing postherpetic neuralgia increases with age. If youre older and develop shingles, youre more likely to develop PHN and have longer lasting and more severe pain than a younger person with shingles. About 10 to 13% of people over age 50 who have had shingles will get PHN. People under age 40 rarely get PHN.
- Weakened immune system: Your immune system weakens as you get older, which allows the inactive varicella-zoster virus to become active again and cause shingles in some people. Medical conditions that can weaken your immune system include cancer, chronic infectious diseases , being an organ transplant recipient or taking medications that weaken your immune system .
- Severity of your shingles: If you have a severe rash, you have a greater chance of PHN.
- Painful, itchy or tingly feeling before shingles rash: If you had these symptoms in an area of skin a few days before your shingles rash broke out, you are at higher risk of PHN.
- Waiting to see your healthcare provider after shingles rash: If you wait longer than three days after your rash appeared missing the window to receive antiviral drugs you have an increased chance of PHN.
Risk Factors For Nerve Pain After Shingles
Researchers have long known that older people are more likely to get PHN, the nerve pain after shingles, but recent studies have found other factors that increase risks.
In one study published in the journal Neurology, researchers including Dworkin looked at data from 965 people with shingles. The researchers identified five risk factors for developing PHN in people who had been recently diagnosed with shingles:
- Presence of symptoms before the rash appeared, like numbness, tingling, itching, or pain
- Severe pain during the illnesss initial stages
Importantly, the researchers found the more risk factors you have, the greater the risk of developing PHN.
For instance, 17% of women with shingles and 26% of those who had severe pain went on to get PHN. But 50% of women who were over age 60 and had symptoms before the rash, severe rash, and acute pain went on to get PHN.
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What Can I Take To Feel Better
Your doctor has a host of ways to treat your pain after shingles, including a variety of medications. They include:
Anticonvulsants: These medications were developed to control seizures, but they can also help reduce the pain of postherpetic neuralgia. Examples are:
Talk to your doctor or pharmacist about side effects of any new prescription or over-the-counter medication.
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:
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Are There Other Ways To Ease The Pain
Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include:
TENS : You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.
Cold packs: Try a gel-filled one to numb the area unless cooler objects make your neuralgia worse.
Comfortable clothes: Go for looser fits and fabrics such as cotton and silk.
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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How Do You Relieve Sciatica Pain In The Calf
This can be accomplished by alternating heat and ice therapy to treat sciatic nerve pain. Heat can aid in healing pain by increasing blood flow to the area . It is also possible to relieve sciatic pain by heating and cooling the body.
It is pain that runs down the back of the legs and down the buttocks as a result of Sciatica. The sciatic nerve, which runs from the lower back to the toes, is irritated or compressed by this condition. Stretches that may help relieve sciatica symptoms are among the treatments available. The sciatic nerve runs through the legs to connect the buttocks to the spine. The flexibility of the hammoral biceps reduces back pain. If any of these exercises worsen sciatic pain, it is critical to discontinue the activity as soon as possible. It is normal for you to feel a stretching sensation during these movements, but not for the pain to rise. Some people suffering from sciatica symptoms can stretch as well as use other home remedies to alleviate their pain and discomfort. The only symptom of a problem with the joint is weakness.
If your sciatica symptoms are persistent, see your doctor right away. If you have a Sciatica, you may need to seek additional treatment.
Preventing Nerve Pain After Shingles
But if youre worried about PHN, dont 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. Thats a very significant improvement. They are also very safe and have few side effects, he says.
But who needs the drugs? Dworkin says theres 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.
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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
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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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Coping With Shingles Pain
If you have shingles, you may be wondering how to cope with the pain:
- Be sure to get plenty of sleep and eat a healthy diet to help boost your immune system.
- Wear comfortable, loose clothing with natural fiber .
- Establish or maintain a regular exercise routine.
- Utilize home remedies to help soothe pain from blisters.
- Engage in activities that help take your mind off of the pain.
- Establish a routine to help manage stress.
- Seek out support when needed from family and friends as well as professional supportive services.
How Is Postherpetic Neuralgia Diagnosed
Postherpetic neuralgia is usually diagnosed based on your symptoms, history of having shingles and physical exam. If youve had a recent case of shingles and have pain in the area where the shingles rash once was, you likely have PHN. Your provider may want to make sure your pain is not caused by something else, but in most cases, no other tests are needed.
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