When Shingles Becomes Painful Postherpetic Neuralgia
In 10% to 20% of these people, however, the pain of shingles keeps hanging on after the rash is gone. “These folks go on to get postherpetic neuralgia, and we’re not exactly sure why,” Ralph tells WebMD. “Either the pain of shingles never leaves, or it resolves, comes back, and never goes away completely.”
PHN typically occurs in the area where the shingles occurred. The pain can be intermittent or constant, and it can take on any of the diverse qualities of shingles pain. Normal touching of the skin can set it off, Ralph adds. This is called allodynia.
The pain of postherpetic neuralgia can interfere with daily activities, exercise, sleep, and sexual desire. Irritability and depression often follow. “Generally, it makes people feel terrible if it can’t be controlled,” Rumbaugh says.
Why the pain of postherpetic neuralgia persists has mystified researchers. It’s not due to ongoing infection by VZV, but is thought to be due to residual damage or inflammation in the nerve after shingles resolves. It’s also impossible to predict who’ll get shingles or postherpetic neuralgia, although age, race, and health seem to have some impact.
What Outcome Can I Expect If I Have Postherpetic Pain
Theres no standard treatment for the symptoms of postherpetic pain . Depending on the severity of your pain, you may start with over-the-counter products. If your pain is more severe, one or more prescription medications may be tried. PHN is difficult to treat. Achieving a complete symptom-free state was achieved in less than half the patients with PHN, according to one study.
PHN tends to happen in older individuals who may have other health conditions, which can complicate treatment and results. Pain can last weeks, months and even longer than a year. In some people, the pain can be debilitating. In most people, PHN lessens with time.
A note from Cleveland ClinicThe best way to not get postherpetic neuralgia is to prevent it from happening in the first place. Varicella-zoster virus causes both chickenpox and shingles. Vaccines are available to protect against developing both of these viral infections.
Once you develop chickenpox, the varicella-zoster virus remains in your body for life. If the virus reactivates and causes shingles, you have a few days around the rash outbreak to see your provider and get an antiviral medication, which can significantly lessen your symptoms. Still, if you develop PHN, your provider has many medications available to manage your symptoms.
Who Should Get The Shingrix Vaccine
The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if:
- Youve had shingles.
- Youre not sure if youd had chickenpox .
- Youve already had the Zostavax vaccine. This vaccine for shingles is no longer available in the U.S. Ask your healthcare provider about the best time to get the Shingrix vaccine.
If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.
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What Are The Symptoms Of Postherpetic Neuralgia
Common postherpetic neuralgia symptoms include:
- Burning, sharp, jagging or aching pain in the area where the shingles rash appeared.
- Itchiness or numbness at or near the area of the former rash.
- Pain that is constant or comes and goes. Pain typically lasts, on average, for three months after the rash has healed, but can last for more than a year or longer.
- Pain at affected skin area can be brought on even with a light touch .
- Pain gets worse at night or in heat or cold temperatures.
Burning Feeling And Red Rash
Between 1 and 5 days after you start to feel the tingling or numb feeling, a red rash will develop on the same area of your skin. Most often, the rash appears on one side of your torso, but it can show up anywhere on your body.
You may also have other symptoms along with the rash, such as:
When the rash starts, you should see a doctor for treatment as soon as possible. Starting antiviral medication treatment within 3 days of the rash first appearing can lower your risk of developing complications, like long-term 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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Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
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How Is Postherpetic Neuralgia Treated
If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir , valacyclovir or famciclovir . These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed.
If your shingles outbreak is not caught early, your healthcare providers has many options to manage your postherpetic neuralgia symptoms.
If your pain is mild, your healthcare provider may recommend:
- Acetaminophen or NSAIDs such as ibuprofen .
- Creams and patches include lidocaine and capsaicin .
If your pain is more severe, your healthcare may prescribe:
- Antiseizure drugs gabapentin and pregabalin .
- Antidepressants, such as escitalopram , quetiapine or amitriptyline.
- Botulinum toxin injections in the area where you are having pain.
Theres no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. You and your provider will discuss options and what makes sense to try for you. Contact your provider if your pain is not lessening after taking your medicine. Take all your medications exactly as prescribed.
Shingles And Chickenpox Contagiousness Comparison
Chickenpox is very contagious when in close contact with an infected person. Before the FDA approval of the chickenpox vaccine in 1995, it was a very common childhood illness. Since then, chickenpox cases have dropped by more than 99%. However, unvaccinated people who have never been infected can catch chickenpox at any age. Patients are most contagious when blisters are present, and they should isolate during this phase of the disease.
Shingles occurs most commonly in people over 50 years old, but it can strike at any age in unvaccinated people who have already had chickenpox. But you cannot get shingles if you havent had chickenpox first. The virus in shingles blisters is not as contagious as in chickenpox blisters, but the varicella-zoster virus is still present in the fluid and transmission is possible.
However, you cant get shingles from someone who has shingles. Direct contact with a person who has shingles can only spread VZV to a person who has never had chickenpox or the chickenpox vaccine. If infected with VZV, they will get chickenpox, not shingles. They can develop shingles later as the virus is now in their body.
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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 Long Does Shingles Last
Most cases of shingles last three to five weeks.
- The first sign is often burning or tingling pain sometimes it includes numbness or itching on one side of the body.
- Somewhere between one and five days after the tingling or burning feeling on the skin, a red rash will appear.
- A few days later, the rash will turn into fluid-filled blisters.
- About one week to 10 days after that, the blisters dry up and crust over.
- A couple of weeks later, the scabs clear up.
Can You Have Shingles Without The Rash
Whether or not shingles can present without a rash is a topic of debate, and for Dr. Gurland, the answer is not simple: Theres a lot of discussion about this because, without the rash, youre left with pain at a single nerve root, and other diseases can cause that. But there are people who present with just pain and while you are confident that they have shingles, they just dont have the typical rash, and they may even respond to some shingles treatments. But its a hard diagnosis to make without the rash. Thats why seeking the care of an infectious disease specialist like those at ID Care is key as experience can play a vital role in the proper diagnosis and treatment of shingles.
How To Prevent Transmission
You cant catch shingles, and you cant give shingles to someone else. But you can give others chickenpox.
After you have chickenpox, the varicella-zoster virus stays dormant in your body. If this virus reactivates, shingles occurs. Its possible to transmit this virus to others who arent immune while the shingles rash is still active. You are contagious to others until all areas of the rash are dried up and crusted over.
To catch the varicella-zoster virus from you, a person has to have direct contact with your rash blisters.
You can help prevent your transmission of the varicella-zoster virus by:
- keeping the rash loosely covered
- practicing frequent handwashing
- avoiding contact with people who may not have had chickenpox or who havent been vaccinated against chickenpox
Last medically reviewed on August 24, 2017
- Cohen KR, et al. . Presentation and management of herpes zoster in the geriatric population.
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If You Have Shingles Symptoms Get Treatment Now And You May Avoid Permanent Nerve Pain
Shingles, a viral infection of the nerve roots, affects 1 million people in the U.S each year. Most people recover from their bout, but for as many as 50% of those over age 60 who have not been treated, the pain doesn’t go away. It can last for months, years, or even the rest of their lives.
These people have what’s called postherpetic neuralgia , the result of the shingles virus damaging the nerves of the skin. In some cases, the pain is mild. In others, even the slightest touch — from clothing or even a breeze — can be excruciating.
“PHN causes a great deal of suffering and high social costs,” says Robert H. Dworkin, PhD, a professor in the department of anesthesiology at the University of Rochester Medical Center in Rochester, N.Y. “It can severely disrupt people’s lives.”
But the good news is that there are drugs that can help treat and even prevent PHN, and doctors are learning more about who is at greatest risk of developing this debilitating condition.
Early Intervention Is The Key To Treatment
Antiviral medicines such as valacyclovir , famciclovir or acyclovir , taken orally, are usually used to treat shingles. When taken at the very beginning, Ralph says, they can improve symptoms and reduce the risk of postherpetic neuralgia.
Starting antiviral treatment for shingles more than three days after symptoms start is generally believed to be ineffective because the virus is no longer reproducing. Still, many doctors will try treating the condition with antiviral drugs after this time.
An aggressive, early approach to controlling shingles pain may also reduce a person’s chance of developing PHN. In one study, people who started taking amitriptyline for shingles pain as soon as a rash appeared had less pain after six months than those taking a placebo.
“Rapid initiation of treatment for shingles is very important,” says Rumbaugh. “If treatment is started in the first three days, it can reduce the chance of postherpetic neuralgia and make it less severe if it does occur.” This window of opportunity is often missed, however, because most people don’t get to the doctor that quickly.
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Ask About Different Treatment Options
You will benefit most from a treatment when you know what is happening and are involved in making decisions. Make sure you understand what your treatment involves and what it will or will not do. Have the doctor give you directions in writing and feel free to ask questions. For example: What are the pros and cons of having surgery at this stage? or Do I have any other choices?
If your doctor suggests a treatment that makes you uncomfortable, ask if there are other treatments that might work. If cost is a concern, ask the doctor if less expensive choices are available. The doctor can work with you to develop a treatment plan that meets your needs.
Here are some things to remember when deciding on a treatment:
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.
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Can Shingles Be Prevented
Shingles cannot be cured, but it can be prevented and treated. The best preventative measure for shingles is to get vaccinated. The vaccine is called Shingrix, and it has proven effective at blocking shingles and even more effective at reducing the severe pain associated with it.
When it comes to who should get the shingles vaccine, Dr. Gurland recommends it for everyone over age 50. It is delivered in 2 doses, with 2 to 5 months between the first and second injections, which are no more painful than typical flu shots. After the first shot, people tend to experience very few side effects. After the second shot, you might have a fever or feel achy for a day or 2.
We want to make shingles a very rare disease, said Dr. Gurland, and right now it isnt. We can fix that by vaccinating people, so my top 3 things to remember about shingles are to get vaccinated, get vaccinated, and get vaccinated.
Its uncommon, but some vaccinated people have gone on to get shingles. However, the vaccine still helps alleviate the severe postherpetic neuralgia pain that people find most worrisome. According to Dr. Gurland, while the vaccine prevents shingles to a significant degree, you really want to be vaccinated to avoid the postherpetic neuralgia.
Other measures that can help prevent varicella-zoster infection include basic infection control practices such as avoiding contact with anyone known to be infected with chickenpox or shingles and washing your hands often.
What You Can Do To Help Recover From Shingles
There is no cure for shingles, but there are medications, including antiviral medications, such as acyclovir or valacyclovir, to help fight the infection.
While your shingles is active, you should:
- Rest and relax. Try moderate activities, such as walking and listening to music that can help take your mind off the pain. For severe pain, your doctor may prescribe narcotic pain relievers, corticosteroids, and anticonvulsants.
- Wear loose-fitting clothes.
- Keep the rash clean and dry. Do not cover it or use ointments, which can prevent the blisters from bursting and beginning to scab over.
- Try cool compresses, calamine lotion, or an oatmeal bath to ease the itching and pain of the rash.
- Dont share bedding, clothing or towels in order to avoid spreading the infection while you have blisters.
There are effective vaccinations available to prevent shingles, so if you have had chickenpox, talk with your healthcare provider about getting protected from shingles.
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