Study Assesses Relief Options Against Shingles Pain
- Study Assesses Relief Options Against Shingles Pain
The painkiller oxycodone is effective at treating the acute pain of shingles, an illness that often causes severe pain which can become long-lasting and sometimes even permanent.
The study, published in the April issue of the journal Pain, is one of the first to carefully evaluate different methods to relieve pain during a course of shingles, which many patients say causes the worst pain they have ever experienced. Effective pain treatment is crucial. Not only can the pain of shingles disrupt peoples quality of life, but it is also possible that the less effectively the pain is treated, the more likely it will become a long-term problem that can change a persons life forever.
Shingles is caused by reactivation of the varicella zoster virus, the same bug that causes chicken pox, and only people who have had chicken pox are vulnerable to shingles. About 20 to 30 percent of people will get shingles at some point in their lives the odds climb to 50 percent for people who live to the age of 85.
For most patients, the first symptom of the infection is pain, quickly followed by a rash where the pain first appeared. The rash appears most often on one side of the chest or face, oftentimes causing dozens of small pimple-sized lesions. Some patients also get flu-like symptoms like a headache and lethargy. The illness usually lasts about three or four weeks.
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.
At Risk For Shingles And Postherpetic Neuralgia
Experts explain the causes and treatments of shingles pain.
If you thought chickenpox was a “once and done” childhood illness, you’re only two-thirds right. For about one million American adults each year, that long-forgotten rash returns in a new painful form: shingles.
The pain of shingles can be excruciating, but the condition goes away in a few weeks — for most people. In some unlucky folks, shingles pain doesn’t end when the rash goes away. It goes on. And on. This is called postherpetic neuralgia , a form of neuropathic pain that can last for months or years, even after the virus is no longer active.
“Postherpetic neuralgia can make people feel truly miserable,” says Jeffrey Rumbaugh, MD, PhD, assistant professor of neurology at Johns Hopkins University and a member of the American Academy of Neurology. “For some, it’s something they live with once in a while. For others, it can be daily, severe pain that may last a lifetime.”
Some people are at higher risk for shingles and postherpetic neuralgia than others. But when used correctly, available treatments can prevent postherpetic neuralgia or at least stop it from becoming a permanent, painful companion.
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Body Pain When Sneezing
Sneezing looks like such a benign pain, however anybody who has ever had painful sneezing will inform you that its anything however. Sneezing is a natural response of your body against bacteria and viruses. Anything that enters your nose may set off the bodys reflex to sneeze, which forces whatever entered to leave the nose often through a violent sneeze.
A sneeze is a procedure that consists of many actions. An inflammation to the nose signals your throat, eyes and mouth to shut. Then the chest muscles agreement and throat muscles unwind. Air is displaced of your mouth and nose to clear the passage. So if its a natural occasion, why does my body hurt when I sneeze?
Other Treatment Recommendations For Shingles
If you think you have shingles, see your doctor as soon as possible. This increases the effectiveness of any treatment your doctor will prescribe for you. The treatment doesnt cure shingles. Its meant to help you manage the pain.
Besides acupuncture, you can use other methods to manage your pain. These include:
- antiviral drugs such as Famvir, Zovirax, and Valtrex
- over-the-counter and prescription pain relievers
- calamine lotion, colloidal oatmeal, andwet compresses
Two vaccines are available for adults ages 50 years and older. The Food and Drug Administration approved Shingrix and Zostavax for use. These vaccines reduce the risk of getting shingles. If an older adult still gets shingles after being vaccinated, the symptoms may be less intense.
Shingrix, made from a dead germ, is the preferred vaccine. People with weakened immune systems can get it. Its risky for this group to get the Zostavax vaccine, which contains a live but weakened germ.
Zostavax has not been sold in the United States since November 18, 2020. If you received this vaccine, the
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How Do Dermatologists Diagnose Shingles
A dermatologist can often diagnose shingles by looking at the rash on your skin.
If there is any question about whether you have shingles, your dermatologist will scrape a bit of fluid from a blister. This will be sent to a lab where a doctor will look at the fluid under a high-powered microscope.
When you have shingles, the fluid contains the virus that causes shingles. Seeing the virus confirms that you have shingles.
Your dermatologist will also ask about your symptoms. Shingles tends to be painful.
When the shingles rash spreads to an eye, it can affect your eyesight
You can reduce this risk by seeing an ophthalmologist immediately.
When To See A Doctor
A person should see a doctor if they are experiencing any early symptoms of shingles, especially if they have a history of shingles or are at a higher risk of developing an acute outbreak of the virus due to any of the risk factors above.
A person undergoing treatment for shingles should follow up with a doctor if:
- the symptoms get significantly worse after treatment
- the symptoms do not go away within a few weeks
- new or different symptoms appear in addition to the rash
- there are signs of secondary infection, such as high fever, an open wound, or red streaks coming out of a shingles lesion
People should also speak to a doctor if they have lasting nerve pain in the affected region after the rash of shingles disappears. This complication, called postherpetic neuralgia, affects
In many cases , a doctor will prescribe an antiviral medication, such as famciclovir, valacyclovir, or acyclovir. Pain-relieving medicine can also help ease symptoms. Calamine lotion, colloidal oatmeal compresses and baths, and cold compresses may ease the itching of shingles.
It is important to refrain from scratching the affected area as this can irritate the blisters and increase the risk of infection.
Some people develop a superimposed bacterial skin infection over their shingles lesions. This infection can be very painful, and it may spread if a person does not receive treatment. Individuals who develop this infection in addition to shingles may require antibiotic treatment or even hospitalization.
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Is There A Vaccine For Shingles
There is a vaccine called Shingrix that is available to prevent shingles. Shingrix is recommended for healthy adults over the age of 50 years. Shingrix is also recommended for adults 19 years and older who have weakened immune systems because of disease or medical therapies .
Two doses, separated by two to six months are required, for the vaccine to be over 90% effective.
Clinical Efficacy Of Gabapentin Extended
In an 11-week study performed by Sang et al, 452 patients were randomized in the US , Russia , and Argentina in order to assess the analgesic efficacy of gabapentin extended-release 1800 mg taken once daily at bedtime in patients with post-herpetic neuralgia. Eligible for inclusion were generally healthy adults with post-herpetic neuralgia of 6 months to 5 years duration following resolution of the herpes zoster rash and a baseline daily pain intensity score 4 on an 11-point Likert scale. Key exclusion criteria were concomitant use of analgesics and an insufficient analgesic response or inability to tolerate doses of gabapentin 1200 mg/day or pregabalin 300 mg/day. The primary endpoint was the mean change from baseline in average daily pain intensity score via baseline observation carried forward scoring. At the end of ten weeks of active treatment, the BOCF change in average daily pain intensity score was 2.1 and 1.6 for gabapentin extended-release and placebo, respectively .17 This study showed that participants who were given Gralise 1800 mg daily had a statistically significant reduction in average daily pain intensity scores compared with placebo , reduced sleep interference due to pain, and a greater percentage of participants reporting being much or very much improved on the patient global impression of change .17
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Postherpetic Neuralgia Treatment: Soothing The Pain
Once postherpetic neuralgia occurs, antiviral drugs can’t treat the pain because ongoing infection isn’t the problem. Instead, treatment aims to soothe and quiet the misfiring nerves that are creating the pain.
There are a variety of oils and creams available at drugstores. Some turn to herbal oils and creams, such as extracts from geranium, lavender, eucalyptus, tea tree, and bergamot.
Others use capsaicin cream, made from hot chili peppers. A drug called Qutenza contains “pure, concentrated, synthetic capasaicin,” according to the FDA. Qutenza can be used every three months and is applied by a doctor via a patch or patches placed for an hour on the places on the skin that hurt. Before applying the patch, the doctor spreads a topical anesthetic on the area to be treated.
Ralph said many people find relief from the anesthetic lidocaine, available in low-concentration creams or patches over the counter, or by prescription in higher concentration patches.
“The lidocaine soaks through the skin and numbs the painful nerve endings,” says Ralph. Lidocaine patches are particularly helpful for people with allodynia, Ralph adds.
If topical creams and oils don’t provide sufficient relief, Ralph recommends asking your doctor about prescription medicines that may help, including some antidepressants, anti-convulsants, and opioids.
What Does Postherpetic Neuralgia Feel Like
You usually have pain on one side of your body, where you had the blisters. The feeling is described as shooting, sharp, or stabbing. Other signs you have neuralgia include:
- It hurts to be touched: Sometimes, you canât bear clothing rubbing on your skin. You might feel discomfort from a light breeze.
- Long-lasting pain: This condition can last 3 months or longer after the shingles rash has healed. In some people, itâs permanent. For most, it gets better over time.
- Other sensations: Sometimes, you might feel burning, itching, tingling, or aching along with the shooting feelings. Some people feel numb or get headaches.
- You may also get a fever and generally feel worn-out.
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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
Skin Care And Itch Relief For Shingles
To relieve itching and discomfort, try:
- A cool, wet compresses on the affected skin
- Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or calamine lotion
- Zostrix, a cream that contains capsaicin
- Antihistamines to reduce itching
Keep your skin clean. Throw away bandages you use to cover your skin sores. Throw away or wash in hot water clothing that has contact with your skin sores. Wash your sheets and towels in hot water.
While your skin sores are still open and oozing, avoid all contact with anyone who has never had chickenpox, especially pregnant women.
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Who Is At Risk For Postherpetic Neuralgia
A case of Shingles is one thing, but postherpetic neuralgia is yet another matter entirely. Shingles pain can be combatted by treating the condition with antiviral medication and topical painkillers. For most people, the pain goes away with the infection.
Yet when the pain persists long after the rashes have gone, its a sign that a person may be suffering from postherpetic neuralgia .
The same rules apply the weaker your immune system, the greater the risk of postherpetic neuralgia. It doesnt have to be a matter of age. Certain illnesses can weaken your immune system. Procedures such as a recent organ transplant can take a toll on your body and force you to take immunosuppressant drugs to minimize the chance of transplant rejection.
There are unknown factors, too. Some people get postherpetic neuralgia others dont.
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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:
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Oatmeal Or Baking Soda Baths
You’ll want to care for your uncomfortable skin safely and effectively while it heals. Soaking in oatmeal or baking soda baths can soothe your skin if you have a shingles rash.
Those home remedies can provide temporary relief for itching and can be soothing, said Dr. Strowd. Look for colloidal oatmeal or baking soda to add to cool bath water. Both of those ingredients can help calm itching and are gentle on the skin.
Grinding oat grain into a fine powder makes up colloidal oatmeal. It softens or soothes the skin because it contains fats, proteins, vitamins, minerals, and other nutrients. You’ll find colloidal oatmeal at many places that sell health and beauty products.
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 38ÃðC 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.
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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 Do Dermatologists Treat Shingles
An antiviral medication can:
-
Reduce the amount of time that you have a shingles rash
-
Lower your risk of developing long-lasting nerve pain and other health problems
One of three antiviral medications is usually prescribedacyclovir, famciclovir, or valacyclovir.
To treat your symptoms, dermatologists typically recommend the following:
Pain: Medication that you can buy without a prescription can help, such as:
If you have severe pain, your dermatologist may prescribe a medication that reduces inflammation, such as a corticosteroid.
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What Causes Postherpetic Neuralgia
Postherpetic neuralgia begins when the virus that causes chickenpox affects an individual. After having chickenpox, the virus remains in the body forever. The virus can reactivate, usually decades later, and produce shingles lesions. The reactivation of the virus is thought to be due to stress on the body from either another infection or if the patients immune system is compromised that allows the virus to escape the nerve cells.
The nerve fibers damaged from the chickenpox virus are unable to transmit normal sensation messages from the skin to the brain. Instead, the sensation messages become confused and exaggerated, causing chronic, often excruciating, pain that can last months or even years. However, postherpetic neuralgia does not occur in everyone who suffers from shingles.