Treatment Of Pain After Shingles
Treatment for people with PHN may include:
- Nerve blocks: Local anesthetic or alcohol injected directly into the nerve affected
- Thoracic epidural injections: Local injection in the space around the spinal cord
- Antidepressant medications: Such as amitriptyline
- Membrane stabilizers: Such as gabapentin
- Capsaicinapplication: Topical cream applied to the affected area
Antidepressants May Offer Surprising Relief
Antidepressants may have been invented for depression, but they are also known to modulate peripheral nerves, Dr. Auwaerter says, thereby dulling PHN pain. Your physician may suggest Pamelor or Aventyl or Elavil . Dr. Auwaerter adds that these medications can sometimes cause side effects like fatigue and sluggishnessthough PHN patients usually only need a low dose, which is unlikely to cause major adverse effects.
How Is Postherpetic Neuralgia Treated
Treatment for postherpetic neuralgia depends on the type and characteristics of pain experienced by the patient. Generally, there is not a single treatment of postherpetic neuralgia that relieves pain in all people. In many cases, it takes a combination of treatments to reduce the pain, and ensure patient comfort.
Possible pain management options include:
Non-drug treatments for postherpetic neuralgia include:
- Acupuncture. The Chinese art of pricking the skin or tissues with very fine needles.
- Moxibustion. A form of heat therapy in which dry plant materials called moxa are burned on or very near the surface of the skin. The intention is to warm and invigorate the flow of Qi in the body and dispel certain pathogenic influences.
- Relaxation techniques. These can include breathing exercises, visualization, and distraction.
- Heat/Cold Therapy. Depending on the patient, hot or cold packs may help reduce pain.
- Transcutaneous Electrical Nerve Stimulation. The stimulation of peripheral nerve endings by the delivery of electrical energy through the surface of the skin.
- Spinal cord stimulator. The electrical stimulation of the posterior spinal cord to block nerve impulses.
In some cases, pain treatment for postherpetic neuralgia brings complete relief. However, most sufferers still experience some pain, while some may not obtain any relief. Although some people must live with postherpetic neuralgia the rest of their lives, the condition often disappears on its own within five years.
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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.
Can Postherpetic Neuralgia Be Prevented
The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. The recombinant herpes-zoster vaccine is recommended to prevent shingles in adults ages 50 and older. The vaccination is given in two doses, two to six months apart. The two-dose vaccine is 90% effective at preventing shingles and PHN. Protection lasts at least for four years after you get vaccinated.
If you have never had chickenpox or have children who have never had chickenpox, getting the chickenpox vaccine can help prevent getting this infection in the first place. If you never get chickenpox, you will not have the varicella-zoster virus in your body and will not get shingles or PHN.
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Suffering From Shingles Pain We Can Help
Roughly one in three people experiences shingles during their lifetime. Shingles is caused by the same virus as chickenpox: the varicella-zoster virus. Chickenpox is generally milder and affects children, while shingles in adults may cause a large, blistering rash and ongoing nerve pain.
If youve ever had chickenpox, the virus remains in your nerve cells forever. It can reactivate years later in the form of shingles. But having had chickenpox doesnt guarantee youll get shingles.
Shingles isnt contagious or life-threatening, but its often very painful. It causes oozing blisters on your skin. The patches can develop anywhere on your body, and they may cause intense pain that makes daily life challenging.
At Ohio Pain Clinic, you can find relief from shingles pain and a complication known as postherpetic neuralgia . Amol Soin, MD and our team offer a range of treatments to relieve lingering PHN pain and help you live more comfortably.
What Is Postherpetic Neuralgia
Postherpetic neuralgia is a complication of shingles infection . Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox.
Shingles causes a painful, blistering rash and other symptoms. The rash most commonly occurs in a band pattern on one side of your body, usually on your trunk . The rash turns into blisters. As the rash/blisters go away, pain may remain. When pain remains, the condition is called postherpetic neuralgia.
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What Are The Pain Complications Of Shingles
Pain, itching, and tingling may continue for several months after the rash healing. At the same time, the pain that remains after the rash has healed may be the most severe complication of shingles. Itching, burning, and pain along the nerves that affect the eyes, nose, mouth, and throat can cause temporary and permanent problems.
How Quickly Does It Relieve Pain
Trigeminal Nerve Blocks can quickly relieve pain for those suffering from Shingles. The blocks work by numbing the trigeminal nerve, which is the nerve that sends pain signals to the brain. This can provide relief within a few minutes and can last for several days or weeks. It is a safe and effective way to manage pain associated with Shingles.
Are Multiple Treatments Needed?
The answer to this question depends on the individual case. Some people only need one treatment, while others may require multiple treatments. The number of treatments needed also depends on the severity of the shingles. In general, the earlier the treatment is started, the fewer treatments will be required.
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Opt For Otc Pain Relievers
Over-the-counter options like Tylenol can ease the discomfort of shingles rash and even mild PHN. At least for early pain, we often use non-steroidal anti-inflammatory drugs , like ibuprofen or naxopren, Dr. Auwaerter notes. Theyre easy to pick up at any drugstore, but theyre not always ideal for frequent and/or long-term use. NSAIDs can cause stomach irritation and stomach ulcers, and can harm the kidneys unless taken with large volumes of water. If you experience abdominal pain or constipation, ask your doctor to help you find another option.
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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What Are The Potential Side Effects
There are a few potential side effects of trigeminal nerve blocks for shingles, but they are generally rare and not overly serious. The most common side effect is temporary numbness or tingling in the area where the block was injected. This usually goes away within a few hours. Other potential side effects include:
-Bleeding or bruising at the injection site
-Infection
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.
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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.
Remedies For Postherpetic Neuralgia Caused By Shingles
Natural remedies are a great way to treat shingles. Seeking medical advice must be your first step, but sometimes medications prescribed by the doctor tend to have side effects. On the other hand, natural remedies do not pose a high level of danger, which is what makes them appealing. Lets have a look at a few home remedies that can help you treat PHN:
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Where Is My Nearest Study Site
Here is a list of all of the sites who are currently recruiting for this study:
- ACT, Canberra Paratus Clinical Research Canberra
- NSW, Sydney Paratus Clinical Research Western Sydney
- NSW, Broadmeadow Genesis Research Services
- SA, Adelaide PARC Clinical Research
- QLD, Brisbane Paratus Clinical Research Brisbane
When Shingles Pain Doesnt Stop: Coping With Postherpetic Neuralgia
Shingles, also known as herpes zoster, will affect about 1 in 3 Americans during their lifetime. For most, the itching and painful rash will run their course over two to four weeks, and that will be the end of it.
Unfortunately, about 10-13 percent of people who develop shingles will continue to have pain after the other symptoms are gone.
This pain, called postherpetic neuralgia, or PHN, usually lasts only a few weeks or months. But for some people, the pain can persist for years. PHN can afflict anyone whos had shingles, but the risk of developing it increases with age.
If youre one of the unfortunate PHN sufferers, your doctor may recommend one of several treatment options:
The best answer, of course, is to never contract shingles and never develop PHN in the first place.
Shingles is caused by the virus that causes chickenpox, and anyone whos had chickenpox can get it, although its more common in older adults. The virus lies dormant in the body and can resurface years after you recover from chickenpox.
Fortunately, vaccines are available that can prevent or lessen the severity of shingles. If youre over 50 and had chickenpox as a child, talk to your doctor about getting the vaccine.
The information contained in this article is for educational purposes only and is not intended to replace or counter a physicians advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
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How Can Acupuncture Help Shingles Pain
Acupuncture involves inserting thin needles into specific parts of the body known as acupuncture points. The professional who performs this technique is called an acupuncturist. Acupuncturists use single use needles and follow the Clean Needle Technique.
When your acupuncturist inserts the needles, you may feel a tingling sensation. If you experience unbearable pain, let them know.
After inserting the needles, your acupuncturist activates them through electrical stimulation or by gently moving them with their hands, or they may not stimulate them at all. Theyll leave the needles in your skin for up to 30 minutes. This process helps your body to release its own naturally occurring painkillers.
Youll undergo this treatment depending on the severity of your case and how your body responds. Treatment may be necessary daily or weekly.
shows that acupuncture can ease pain in conditions such as migraine and back pain. Various studies have been conducted to see whether acupuncture can also treat shingles pain.
In 2011, a showed that acupuncture could be used for the treatment of shingles pain, or acute herpetic pain. Acupuncture may also improve quality of life and reduce anxiety in people with shingles.
More recently, researchers found that adding acupuncture to traditional antiviral therapy in three key phases of shingles:
- the pain before the blisters appeared
- the time it took for the blisters to scab over
- the time it took for blisters to stop forming
I Think I Have Shingles What Should I Do
Repeat after me: Call your doctor right away, within 72 hours. The earlier the better.
You should start taking an antiviral medication, preferably valacyclovir or famciclovir, within 72 hours of your symptoms starting to help reduce the severity of the infection, how long your skin rash lasts, and how painful it gets. If its been more than 72 hours, you should still talk to your provider. Treatment can still help, especially if you still see new rashes showing up.
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Who Can Take Part In This Study
In order to be eligible to participate in the study, you must meet all of the following:
- You are aged 18 years or older.
- You are experiencing nerve pain that has persisted for at least 3 months after the shingles rash has healed.
- You are willing and able to comply with e-diary data collection and to attend 10 scheduled study visits over the course of 14 weeks.
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:
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What Is Shingles
Shingles is a painful rash, which is a result of a viral infection. It usually occurs when the varicella zoster virus is reactivated in the nerves.
It causes pain, a tingling sensation or burning sensation, which usually leads to nerve pain. VZV is the same virus that, which causes chickenpox.
In most people, the virus remains dormant and strikes again later becomes active due to an unknown trigger.
Shingles develop only when you have previously had chickenpox. In some cases, when a persons immune system is weak due to the treatment or diseases, VZV can strike again.
The three symptoms that people experience on the early onset of shingles are:
- Light sensitivity
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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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.