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Medication For Nerve Pain From Shingles

New Drug For Lingering Shingles Pain

Shingles, zoster, and post-herpetic neuralgia

FDA Approves Qutenza for Postherpetic Neuralgia

Nov. 17, 2009 â The FDA has approved a new treatment for postherpetic neuralgia , the nerve pain that sometimes lingers after an attack of shingles.

The new PHN drug is Qutenza. Itâs made by Lohmann Therapie-Systems AD of Andernach, Germany, and distributed by NeurogesX Inc. of San Mateo, Calif.

PHN is excruciating, and is often described as a burning, stabbing, or gnawing pain. It starts with an attack of shingles, in which the herpes zoster virus â the chickenpox virus, lying dormant at nerve roots â reactivates.

PHN is pain that persists after the shingles scales heal. It affects 10% to 15% of people who have shingles. It may get better over time. It may not. Treatments include prescription pain medications, anticonvulsants, and antidepressants.

Now thereâs Qutenza, a radically different approach. The active ingredient in Qutenza is synthetic capsaicin, the chemical that makes chili peppers burn. There are over-the-counter capsaicin products, but the FDA notes in a news release that âQutenza is the first pure, concentrated, synthetic capasaicin-containing prescription drug to undergo FDA review.â

âThe product can provide effective pain relief for patients who suffer from PHN,â Bob Rappaport, MD, FDA director of Anesthesia, Analgesia, and Rheumatology Products, said in a news release.

Patients may receive an opioid pain drug before or after treatment.

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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.

Coping With Shingles Pain

If you have shingles, you may be wondering how to cope with the pain:

  • Be sure to get plenty of sleep and eat a healthy diet to help boost your immune system.
  • Wear comfortable, loose clothing with natural fiber .
  • Establish or maintain a regular exercise routine.
  • Utilize home remedies to help soothe pain from blisters.
  • Engage in activities that help take your mind off of the pain.
  • Establish a routine to help manage stress.
  • Seek out support when needed from family and friends as well as professional supportive services.

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Types Of Pain: Nociceptive Vs Neuropathic

  • Nociceptive pain comes from damaged tissues outside the nervous system, such as muscles and joints. People say the pain feels aching and throbbing.
  • Neuropathic pain comes from the nerves that transmit pain signals from the body to the brain. People describe the pain as burning, stinging, or shooting. It may radiate from one area of the body to another. It may be accompanied by numbness and tingling.

Image: Thinkstock

Doctors usually try one type or the other , although they can be combined. They are taken daily in addition to conventional pain relievers.

Why Does The Pain Persist In Some People

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The symptoms of PHN can last for several months in some people. Shingles causes inflammation of the nerve. Pain can be expected whilst the rash and inflammation occur. However, it is not clear why some people continue to have pain when the inflammation has gone. It is thought that some scar tissue next to the nerve, or in the nearby part of the spinal cord, may be a factor. This may cause pain messages to be sent to the brain.

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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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Shingles Symptoms: What Should You Look For

Unlike the whole-body rash of chickenpox, the shingles rash is limited to the area of skin assigned to the infected nerve. The rash usually consists of small bumps that may turn into blisters before bursting and crusting over. If shingles appears on the face, the eye can be affected, posing a threat to sight.

Also unlike chickenpox, this rash hurts, sometimes intensely. People typically describe shingles pain as burning, stabbing, or electrical.

âShingles can be almost unbearably painful,â says Jeffrey Ralph, MD, assistant professor of neurology at the University of California in San Francisco and a fellow of the Neuropathy Association. âThe nerve itself is inflamed. The pain can sometimes come even weeks before a rash appears.â

Soak In A Colloidal Oatmeal Bath

New treatment for the pain of shingles

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.

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Liquid Dimethyl Sulfoxide And Idoxuridine

Idoxuridine is an antiviral medication approved in Europe for treating shingles.

One 2015 publication suggested frequent application of 5 to 40 percent idoxuridine dissolved in DMSO may speed up the healing time of shingles. However, in the United States, idoxuridine is only FDA-approved to treat keratitis, a herpes simplex virus infection of the cornea of your eye.

The Emotional Toll Of Nerve Pain After Shingles

Researchers are not just looking at biological and neurological risk factors for PHN. Dworkin was also a co-author of a study looking at psychological risk factors, too. The results were published in the Journal of Pain in 2005.

“It certainly looks like psychological stress can be a potent risk factor for PHN,” Dworkin tells WebMD.

The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.

Dworkin says previous studies have already shown a connection between stress and shingles development.

“One study even found that the risk of developing PHN was higher in people who were living alone when they developed shingles than people living with others,” Dworkin says, perhaps indicating that social isolation increases the risks of PHN.

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What Is Shingles And Postherpetic Neuralgia

Shingles is caused by the varicella-zoster virus, the virus that also causes chickenpox. In a person who has been exposed to chickenpox — or its vaccine — the virus never really goes away. It can lie dormant in the body’s nerves.

In most cases, it stays that way. But in some — especially people with immune systems weakened by disease or treatment — the virus can reappear. This is likely to happen years or decades after the person had chickenpox.

When it comes back, the virus can cause shingles, a rash that often appears as a band on one side of the body. Early shingles symptoms can include:

  • Flu-like symptoms

Itching, tingling, or extreme pain where the rash is developing may come next, and the pain can be moderate to severe.

Are you contagious? Though people who haven’t had chickenpox can catch that condition from you, the shingles itself isn’t contagious.

For reasons that experts don’t really understand, the pain of shingles lingers for some. If the pain lasts for at least 3 months after the shingles rash has healed, a person is diagnosed with PHN. In some people, the pain will subside. In others, it won’t.

“We don’t have any idea why the pain goes away in some people and not others,” says Dworkin. But the longer you have PHN — especially after a year — the less likely it is to resolve, he says.

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EMLA cream is a prescription medication made up of a 1-to-1 ratio of 2.5 percent lidocaine and 2.5 percent prilocaine.

A 2018 case study of one person found that EMLA cream may make an effective alternative to lidocaine cream for treating PHN in people with special situations like kidney failure. However, theres not much available research about its effectiveness. Most existing research is from the 1980s and 90s.

A doctor can give you specific instructions on how to use EMLA cream.

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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.

Whats The Difference Between Cream Lotion And Ointment

Ointments, lotions, and creams are three types of substances you can apply to your skin to help manage shingles.

These topicals are similar, but there are slight differences in their makeup. The primary difference is the amount of water and oil they contain.

According to this 2016 primer, creams are made up of about equal parts oil and water and often have moisturizing properties. Theyre thicker than lotions but thinner than ointments.

Lotions are similar to creams, but they are made up mostly of water. They have less oil and have a thinner consistency. Because theyre thinner, your skin absorbs them more quickly. Some lotions are oil-free.

Ointments are the thickest of the three. They are made to stay on top of your skin instead of being absorbed immediately. Ointments are made up of at least 80 percent oil.

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How Should I Take Gabapentin

Take gabapentin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take in larger or smaller amounts or for longer than recommended.

If your doctor changes your brand, strength, or type of gabapentin, your dosage needs may change. Ask your pharmacist if you have any questions about the new kind of gabapentin you receive at the pharmacy.

Both Gralise and Horizant should be taken with food.

Neurontin can be taken with or without food.

If you break a Neurontin tablet and take only half of it, take the other half at your next dose. Any tablet that has been broken should be used as soon as possible or within a few days.

Swallow the capsule or tablet whole and do not crush, chew, break, or open it.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device .

Do not stop taking this medicine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor’s instructions about tapering your dose.

In case of emergency, wear or carry medical identification to let others know you have seizures.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using gabapentin.

Store both the tablets and capsules at room temperature away from light and moisture.

Store the liquid medicine in the refrigerator. Do not freeze.

Who Gets Postherpetic Neuralgia

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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 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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Topicals Are Not A Substitute For Medical Treatment

Topical products can help you manage your symptoms. But they arent a substitute for proper medical treatment.

Its important to visit your doctor if youre dealing with shingles. Your doctor can prescribe antiviral drugs and other medications that can shorten the duration of your infection and help you avoid severe complications.

The following creams may be able to help you manage shingles symptoms.

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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.

Can Shingles And Postherpetic Neuralgia Be Prevented

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Shingles can only be prevented if you never have chickenpox, or if you have very good immunity against the chickenpox virus . Most people in the UK have chickenpox as a child. However, immunity to the chickenpox virus reduces as you become older.

There is a vaccine against the varicella-zoster virus which is now offered routinely to people in the UK aged 70-79 years. The efficacy of the vaccine declines with age and so it is not recommended for people aged 80 years or older. This vaccine is the most effective way of preventing the development of PHN. It is a very effective and safe vaccine.

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Shingles And Postherpetic Neuralgia: What Are The Risk Factors

You canât control whether youâll catch the chickenpox virus. Fully 99.5% of adults in the U.S. carry it, whether or not they remember having had chickenpox. But why do one-third of those people get shingles â and some of them go on to develop postherpetic neuralgia?

The risk of postherpetic neuralgia also goes up with age. More than 80% of cases of postherpetic neuralgia occur in people over 50 years old. âItâs likely that the natural decline of immunity with age is responsible,â says Ralph.

The results of one study showed that age had a huge effect on the risk for postherpetic neuralgia after shingles:

  • Among people under 60 years old who had shingles, less than one in 50 developed postherpetic neuralgia.
  • In people aged 60 to 69, about 7% of shingles sufferers developed postherpetic neuralgia.
  • In those age 70 and older, almost 20% developed postherpetic neuralgia after a bout of shingles.

Race seems to matter, too. For unknown reasons, white Americans get shingles and postherpetic neuralgia at more than twice the rate of African-Americans in their age group.

âPeople whose immune systems are impaired by drugs or diseases like AIDS are also more prone to zoster and PHN,â adds Ralph.

Exposure to someone with chickenpox or shingles does not increase your personal risk, however. In fact, experts believe that the slight immune stimulation may boost natural defenses, making you less likely to develop shingles or PHN.

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