What Causes Nerve Pain
Nerve pain can be due to problems in the central nervous system , or in the nerves that run from there to the muscles and organs. It is usually caused by disease or injury.
Common causes include:
- trapped nerves, such as in carpal tunnel syndrome
There are other conditions associated with nerve pain.
Sciatica is pressure on the nerves of the lower back that causes pain down the leg. The pain can be accompanied by pins and needles, numbness or weakness in the leg.
Fibromyalgia is a chronic pain syndrome associated with burning or aching pain in different parts of the body. The cause is not well understood, but it can be triggered by emotional distress and poor sleep. There may be genetic factors, too.
Peripheral neuropathy occurs when the peripheral nerves that connect the brain and spinal cord to the rest of the body are damaged. Its caused by diabetes, autoimmune diseases and other conditions.
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.
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 illness’s 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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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.
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.
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Look For A Lidocaine Patch
Lidocaine is an anesthetic agent that temporarily numbs the area where it’s applied, which can help with PHN pain. With significant postherpetic neuralgia, I find that the topical lidocaine patch is usually the most useful, says Camille Kotton, M.D., clinical director of transplant and immunocompromised host infectious diseases at Massachusetts General Hospital in Boston. Lidocaine is available as a prescription or OTC, though Dr. Kotton notes it can be difficult to get covered by insurance.
Which Antiviral Medication Is Best For Shingles
The antiviral medications used to treat shingles are , , and . They are all effective at helping shingles rashes crust over and heal, and they help reduce pain as you are healing.
In head-to-head studies, a 7-day course of valacyclovir worked faster than a 7-day course of acyclovir at reducing pain. Famciclovir is equivalent to valacyclovir for healing shingles rashes and reducing pain from them. Acyclovir needs to be taken 5 times a day, while Famciclovir and valacyclovir both need to be taken 3 times a day.
Its worth noting that these antiviral medications dont prevent postherpetic neuralgia, which can happen to some people with shingles. And antiviral ointments like Zovirax will do nothing for the rash from shingles.
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Rebooting The Nervous System
Its like restarting a computer, Dr. Rosenquist says. When its running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully, it will send an appropriate transmission as opposed to a pain transmission.
Treatmentoptions for PHN patients include:
Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.
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Shingles On The Face: Symptoms Treatments And More
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Shingles on the face
Shingles, or zoster, is a common infection that occurs due to a herpes virus.
Shingles is a rash that usually appears on one side of the chest and back. It can also develop on one side of the face and around the eye.
The condition can be very painful and can sometimes have long-term side effects. No cure for shingles is available, but early treatment can lower your risk of serious complications.
second most common rash site is the face. It can spread from the ear to the nose and forehead. It can also spread around one eye, which can cause redness and swelling of the eye and surrounding area. The shingles rash occasionally develops in the mouth.
Many people feel a tingling or burning sensation days before the first red bumps appear.
The rash starts out as blisters filled with fluid, or lesions. Some people have a few clusters of blisters scattered about, and others have so many that it looks like a burn. The blisters eventually break, ooze, and crust over. After a few days, the scabs start to fall off.
Other symptoms of shingles are:
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Soak In A Colloidal Oatmeal Bath
This DYI option hasnt been tested for shingles specifically but experts say it may provide some skin relief while your rash is still acting up. Colloidal oatmeal is made by grinding oats into a fine powder . A study in the Journal of Drugs in Dermatology found that this natural remedy has antioxidant and anti-inflammatory properties which can make it helpful in treating irritated skin. Add colloidal oatmeal to a bath of cool or lukewarm water and soak for about 10 minutes, once per day, for as long as your rash lasts.
Who Gets Postherpetic Neuralgia
About 1 out of 5 people who have shingles will have these sharp, ongoing pains afterward. Certain things can increase your chances of getting it:
- Age: Most people who get postherpetic neuralgia are older than 60.
- Gender: Women seem to get it more than men.
- Early symptoms: People who have numbness, tingling, or itching before a shingles rash even appears tend to get the lingering pain later.
- Pain at the start: If you had severe pain or a rash during the beginning of your outbreak, you have a greater chance of the neuralgia later.
- Other health problems: People with ongoing conditions that can weaken the immune system, like HIV and cancer, seem more likely to get it.
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How Can You Prevent Spreading The Virus
You cant give shingles to someone else, but the varicella-zoster virus is very contagious. If you have shingles and you expose someone else who has not had chickenpox or the chickenpox vaccine, you can give them the virus. Theyll get chickenpox, not shingles, but this puts them at risk for shingles later on.
Youre contagious when your blisters are oozing, or after they break and before they crust over. Do the following to avoid spreading the virus to others:
- Keep your rash covered, especially when the blisters are active.
- Try not to touch, rub, or scratch your rash.
- Wash your hands thoroughly and often.
Avoid contact with people whove never had chickenpox or the chickenpox vaccine, especially:
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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Why Shingles Can Be Painful
Before we walk you through treatment options, lets look at why this virus can cause pain. The varicella zoster virus develops a latency after chickenpox in these nerves called dorsal root ganglia, explains Paul Auwaerter, M.D., clinical director of the division of infectious diseases at Johns Hopkins Medicine in Baltimore. What can happen is, for reasons that arent entirely clear, the virus can reactivate within a nerve. The virus then travels along that pathway to the skin, causing a painful rash. In serious cases, it can lead to lasting nerve damage called postherpetic neuralgia, or PHN.
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How Long Does Postherpetic Neuralgia Last
Postherpetic neuralgia can last for weeks, months, or in some people, years after the shingles rash goes away. In most people, shingles pain goes away in one to three months. However, in one in five people, pain lasts more than one year.
The pain from PHN can be so severe in some people that it disrupts their life. Researchers dont know why some people have severe or long-lasting pain and others do not.
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What Increases The Risk Of Long
The risk of developing post-herpetic neuralgia increases with age. Four weeks after getting shingles,
- 27% of 55- to 59-year-olds and
- 73% of over 70-year-olds had nerve pain.
Women seem to be more likely to have longer-lasting nerve pain than men. Post-herpetic neuralgia is also more likely to develop if your eyes were affected by shingles.
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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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.”
What Is Nerve Pain
Nerve pain, also called neuralgia or neuropathic pain, occurs when a health condition affects the nerves that carry sensation to the brain. It is a particular type of pain that feels different from other kinds of pain.
There are different types of nerve pain, including:
- post-herpetic this can happen after you’ve had shingles and affects the same area as the shingles rash
- trigeminal causing pain in the jaw or cheek
- occipital causing pain at the base of your skull that can spread to the back of your head
- pudendal causing pain in the saddle area between the legs
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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.
Are There Treatments I Can Put On My Skin
You might find relief with topical treatments. You can talk to your doctor about:
Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin and Zostrix. You can buy this over the counter but make sure your doctor knows if you plan on using these.
Patches: Capsaicin is also in Qutenza, which is applied via a patch for one hour every 3 months. You need to visit the doctorâs office for this.
Lidoderm is a patch that has a numbing agent called lidocaine. Itâs applied directly to the painful area of skin. You need a prescription.
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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: