How Is Shingles Diagnosed
Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.
Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.
The healthcare provider may also take skin scrapings for testing.
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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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
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What Can I Do For The Pain
Not everyone has the same amount of pain from shingles. Over-the-counter pain medicine like acetaminophen and ibuprofen can help ease the pain. A liquid medicine that you put on your skin can help cool the rash and stop the itching. Your doctor can give you pain medicine if your rash hurts a lot.
Sometimes the pain does not go away with the rash. This is called postherpetic neuralgia .
Shingles And Your Eyes
If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.
Shingles painand other symptoms from an outbreak of herpes zosterusually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, its called postherpetic neuralgia .
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What Are The Symptoms Of Shingles
Usually, shingles develops on just one side of the body or face, and in a small area. The most common place for shingles to occur is in a band around one side of the waistline.
Most people with shingles have one or more of the following symptoms:
- Fluid-filled blisters
- Tingling, itching, or numbness of the skin
- Chills, fever, headache, or upset stomach
For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze. Its important to talk with your doctor if you notice any shingles symptoms.
If you notice blisters on your face, see your doctor right away because this is an urgent problem. Blisters near or in the eye can cause lasting eye damage and blindness. Hearing loss, a brief paralysis of the face, or, very rarely, inflammation of the brain can also occur.
Why Does Postherpetic Neuralgia Happen
Postherpetic neuralgia starts out with a very familiar illness: chickenpox. The virus that causes it is called varicella-zoster. Once chickenpox has run its course, the virus âhides outâ in your nervous system.
Doctors arenât sure exactly why, but sometimes the virus reactivates decades later and travels along pathways to your skin. A painful, blistering rash can erupt. Thatâs shingles.
In some cases, shingles can damage your nerves so that they canât send messages from your skin to your brain as they usually do. That scramble of signals can trigger the ongoing pain of neuralgia.
If the pain lasts more than a year, it can become permanent.
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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.
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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?
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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.
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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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.
What Are Typical Symptoms Of Post
The symptoms of PHN are very often limited or localised to the area of skin where the shingles outbreak first occurred.1 This is why PHN is often referred to as being a type of localised neuropathic pain.3
The chronic pain associated with PHN can be described as burning pain, stabbing pain, itching or aching. Patients with PHN often have hypersensitive skin, like a bad sunburn, and may feel severe pain from the touch of clothing on the affected area, a condition doctors call allodynia.1,4
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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.
Lasting Pain After Shingles
Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. Its still not clear how it can be prevented or what the best treatment is.
Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word post-herpetic means post-herpes because the pain arises after infection by the herpes zoster virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.
The main symptom of post-herpetic neuralgia is pain in the nerves . The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.
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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.
How Acupuncture Can Relieve Shingles Pain
Shingles, also known as herpes zoster, is an infection caused by the varicella- zoster virus, the same virus that causes chickenpox.
According to the Centers for Disease Control and Prevention , as many as 1 in 3 people in the United States will get shingles. Anyone who has had chickenpox can get shingles, but its most common in adults over the age of 50.
When you have shingles, youll first develop a rash that turns into blisters. Before the rash appears, youll likely feel pain in the affected area.
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The pain and rash from shingles affect one side of the body. Areas commonly affected include:
If youre experiencing pain from shingles, you may be wondering if acupuncture can help. Acupuncture is a form of traditional Chinese medicine thats commonly used to treat pain. In fact, theres been some research exploring acupuncture specifically for 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.
Treatment Of Herpes Zoster
The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
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Tips For Coping With Shingles
If you have shingles, here are some tips that might help you feel better:
- Wear loose-fitting, natural-fiber clothing.
- Take an oatmeal bath or use calamine lotion to soothe your skin.
- Apply a cool washcloth to your blisters to ease the pain and help dry the blisters.
- Keep the area clean and try not to scratch the blisters so they dont become infected or leave a scar.
- Do things that take your mind off your pain. For example, watch TV, read, talk with friends, listen to relaxing music, or work on a hobby such as crafts or gardening.
- Get plenty of rest and eat well-balanced meals.
- Try simple exercises like stretching or walking. Check with your doctor before starting a new exercise routine.
- Avoid stress. It can make the pain worse.
Also, you can limit spreading the virus to other people by:
- Staying away from anyone who has not had chickenpox or the chickenpox vaccine, or who might have a weakened immune system
- Keeping the rash covered
Spinal Cord Or Peripheral Nerve Stimulation
These are often used to treat several different types of neuropathic pain. Electrodes are placed underneath the skin along the affected peripheral nerves. Before using this technique, doctors will do a test using a wire electrode to get a sense of how the patient will respond.
After the electrodes have been placed above the peripheral nerve, a weak electrical current is sent to the nerve. By stimulating a sensory pathway that doesnt cause pain, experts believe that this electrical signal to the brain can trick the brain into turning off the painful signal, bringing relief to the patient.
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Understanding Chronic Shingles Pain
If you had chickenpox as a child, you may be at risk of developing shingles as an adult, as both conditions are produced by the same virus: varicella-zoster. Even after the condition has improved and symptoms have disappeared, people never truly recover from the disease. The virus lies dormant in the body and has the potential to resurface later in life. Research suggests that the virus comes back as an individual gets older and their immune system becomes weaker. The pain management specialists at Southwest Spine and Pain Center are able to help patients understand what shingles pain is and how to prevent it from becoming chronic.
Understanding Shingles Pain
Shingles typically begins with pain and other symptoms such as sensitivity to touch, numbness, or tingling. After a few days, the condition progresses into a painful, blistering rash. Shingles patients may also experience fevers, headaches, and body aches. Depending on the location of the pain, patients may mistake their symptoms with heart, lung, or kidney problems. Nevertheless, some people with shingles never develop a rash, or really intense, sharp pains. Some shingles patients have reported pain flare-ups from certain triggers like brushing skin across furniture or from the wind hitting their bodies.
Avoiding Chronic Pain
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 doesnt go away. It can last for months, years, or even the rest of their lives.
These people have whats 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 peoples 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.
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