Nerve Blocks For Shingles Pain
The same virus responsible for chicken pox during childhood causes shingles pain as an adult. The virus becomes active in nerve tissue causing severe pain usually on one side of the body. This occurs more frequently in people older than 60, but can occur in younger individuals. Shingles usually presents in sharp pain followed by a rash. The more likely areas to be affected include the chest or abdomen, and less frequently, the face, the arms, or the legs.
Reasons for treatment
A shingles infection causes a very severe nerve inflammation that if left untreated can evolve into a more severe form of the disease called post-herpetic neuralgia. This disease is a complication of shingles where nerves and their blood supply have been severely damaged from inflammation. Typically. the older you are and the more pain you have during your shingles episode, the more likely it is for you to develop permanent pain. Blocking the pain in the affected nerves using strong numbing medicines and anti-inflammatories will shorten the actual shingles pain and may decrease the chance of developing severe nerve damage and chronic pain.
Procedures
When Should I See My Doctor
See your doctor as soon as possible if you are experiencing any symptoms of shingles. Starting treatment with antiviral medicines within 3 days of the rash appearing should reduce the severity of symptoms and the risk of further complications, including post-herpetic neuralgia.
See your doctor straight away if you have symptoms of shingles and are experiencing the following:
- symptoms that affect your eye area
- a temperature of 38°C or higher
You should also see your doctor if you are pregnant, or have a weakened immune system due to medicine that suppresses the immune system, or a condition that weakens your immune system.
Can I Give Shingles To Others
No one can catch shingles from you, but they can catch chickenpox if they have not already had it or had the shot. The chickenpox virus lives in the spots from shingles, and the virus can be spread until the spots are completely dried up. If you have shingles, you should stay away from babies younger than 12 months and pregnant women.
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How To Prevent Arm Pain After A Vaccine
There are a couple of things you can do to lower your chances of having severe pain in your arm from a shot. In addition, you can take certain steps after a vaccine to decrease any pain or discomfort.
Try these tips before and after you get your next vaccine:
1. Relax your arm
Obviously, its normal to tense up a bit when the doctor or nurse pulls out that needle. While it might be easier said than done, the best thing you can do to prevent pain is to simply relax your arm or shoulder before the injection.
If the muscle actually tenses during the injection, that can create more damage, inflammation and discomfort, says Dr. Allan.
Simply take some deep breaths and find a distraction so the additional tension doesnt cause more pain. For children, try and distract them with something so theyre not focusing too much on the needle.
2. Find the right time
If you can help it, try not to schedule a vaccine spontaneously or at the last minute. Its helpful to plan ahead and pick a date when you dont have other items on your schedule.
For example, make sure that you arent scheduling a shot on a day you might need to do strenuous activities. Also, try and avoid getting your shot in the arm you use the most that way, you can let your injected arm relax and heal with no worries.
3. Take OTC pain relievers beforehand
4. Apply ice and compression
Wrapping your arm under compression, especially early on, also helps reduce inflammation, notes Dr. Allan.
5. Stretch
A Word About The Shingles Vaccine
If you are age 60 or over and have not had shingles, talk to your doctor about getting the shingles vaccine. Not only will it reduce your risk of developing shingles, but if you do develop shingles, youll be more likely to have a mild case. And, just as important, youll be much less likely to develop PHN if youve had the vaccine.
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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.
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.
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Treating The Pain Of Phn
Exactly how best to deal with the pain is a difficult question. Rice led a research team that looked at 35 clinical trials of various treatments. The findings appear in the July issue of the free-access online journal PloS Medicine.
“The most important thing to realize is these are painkillers,” Rice says. “You are treating the pain, not the disease itself. And this is due to permanent nerve damage. It is like a stroke. We can’t make the nerve damage better, but we can treat the disability. And for PHN, pain is one of those disabilities.”
What helps? Rice’s team found good evidence supporting:
When Should I Get The Shingles Vaccine
The current shingles vaccine is a safe, easy, and more effective way to prevent shingles than the previous vaccine. In fact, it is over 90% effective at preventing shingles. Most adults age 50 and older should get vaccinated with the shingles vaccine, which is given in two doses. You can get the shingles vaccine at your doctors office and at some pharmacies.
You should get the shingles vaccine if you:
- Have already had chickenpox, the chickenpox vaccine, or shingles
- Received the prior shingles vaccine called Zostavax
- Dont remember having had chickenpox
Medicare Part D and private health insurance plans may cover some or all of the cost. Check with Medicare or your health plan to find out if it is covered.
You should not get vaccinated if you:
- Currently have shingles
- Are sick or have a fever
- Had an allergic reaction to a previous dose of the shingles vaccine
If you are unsure about the above criteria or have other health concerns, talk with your doctor before getting the vaccine.
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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.
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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What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.
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.”
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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 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.
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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.
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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Pain And Sensitivity Management
For some individuals, the pain associated with shingles can get pretty intense, and increased sensitivity can make even a cool breeze feel excruciating. To manage discomfort, try using one of the following methods, or combine them to find what works for you.
- Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help relieve bodily pain, as well as ease headaches and reduce fever. Talk to your healthcare provider before taking any of these medications, however, because some may cause issues with your stomach or liver, depending on your medical history or dosage.
- Cool compresses can be made using a washcloth held under cool water. Avoid using ice packs because extreme temperatures can make the pain worse or hurt sensitive skin.
- Hypnosis has been shown to help relieve various forms of pain, though it might not work for everyone.
- Comfort therapylike listening to music, talking with friends, or doing other activities you enjoycan help keep your mind off of the pain.
- Wearing loose clothing, especially in areas where you might have increased sensitivity, can also help limit the likelihood of experiencing additional discomfort.
For those with severe pain or postherpetic neuralgia a complication from shingles that can cause long-term painthese coping strategies might not be enough. In those instances, healthcare providers might recommend using medications such as gabapentin or pregabalin to manage the pain.