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Who Is At Risk Of Getting Postherpetic Neuralgia
Factors that increase the risk of developing postherpetic neuralgia include:
- Older age: The chance of developing postherpetic neuralgia increases with age. If youre older and develop shingles, youre more likely to develop PHN and have longer lasting and more severe pain than a younger person with shingles. About 10 to 13% of people over age 50 who have had shingles will get PHN. People under age 40 rarely get PHN.
- Weakened immune system: Your immune system weakens as you get older, which allows the inactive varicella-zoster virus to become active again and cause shingles in some people. Medical conditions that can weaken your immune system include cancer, chronic infectious diseases , being an organ transplant recipient or taking medications that weaken your immune system .
- Severity of your shingles: If you have a severe rash, you have a greater chance of PHN.
- Painful, itchy or tingly feeling before shingles rash: If you had these symptoms in an area of skin a few days before your shingles rash broke out, you are at higher risk of PHN.
- Waiting to see your healthcare provider after shingles rash: If you wait longer than three days after your rash appeared missing the window to receive antiviral drugs you have an increased chance of PHN.
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.
Read Also: How To Administer Shingles Vaccine
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?
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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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.
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.
Also Check: What Do Pictures Of Shingles Look Like
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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 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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Have Shingles Get Treatment Take Action
If you have shingles, it’s important to talk to your doctor about your risk for developing PHN. Ask whether preventative treatment with antiviral drugs makes sense. If your doctor says it’s not necessary, ask why.
The full implications of the psychological risk factors for PHN aren’t clear yet, says Dworkin. But he suggests that people with shingles should try to stay active and connected.
“If psychological distress is a risk factor for PHN,” he says, “then we think that people who have shingles might benefit from getting out and not being isolated and homebound.”
You might make an effort to stay connected to family and friends and not to dwell on your symptoms. Also, keep in mind that even if you do develop PHN, there are treatments that can help.
“We have about a half dozen types of drugs that are used as first-line treatments for PHN,” says Dworkin. They include lidocaine patch , pregabalin , gabapentin , capsaicin , carbamazepine , tricyclic antidepressants, and painkillers.
The most important thing is to get prompt medical attention if you think you might have shingles.
“If you have a one-sided rash — especially if you’re over 50 — see your doctor right away,” says Dworkin. “It could be shingles. And we know that prompt treatment can dramatically reduce the likelihood of developing long-term pain.”
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Preventing Shingles In The Eye
When it comes to shingles and especially ocular shingles prevention is the best medicine.
Fortunately, there are two shingles vaccines:
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Shingrix A fairly new vaccine, Shingrix is recommended for adults ages 50 and over. You get Shingrix in two doses two to six months apart, and its more than 90% effective in protecting you from shingles and post-herpetic neuralgia. Protection stays strong for at least four years after you get vaccinated.
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Zostavax An older vaccine for shingles, Zostavax is a live vaccine that is less effective but may be used in healthy adults ages 60 and up if theres a reason they cant have Shingrix administered. For example, someone who is allergic to a component of Shingrix may opt for Zostavax.
The availability of a newer, more effective vaccine should prevent even more shingles outbreaks. We recommend the vaccine for all of our patients, Dr. Rapuano says.
WORRIED YOU MIGHT HAVE EYE SHINGLES ?Find an optician near you and schedule an appointment.
Page published in May 2020
Find an optician near you
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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.
What Should I Expect Will Happen To Me If I Get Shingles
Shingles can be a very painful condition. If you think you have the symptoms of shingles, see your healthcare provider right away. Starting antiviral medications early can ease your discomfort and reduce the duration of your symptoms.
A better approach to shingles is to take action and do what you can to lessen your risk of getting it. If you never had shingles or had a bout of them in the past, talk to your healthcare provider about getting the shingles vaccine. If youve never had chickenpox, talk with your healthcare provider about getting the chickenpox vaccine.
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What Can I Take To Feel Better
Your doctor has a host of ways to treat your pain after shingles, including a variety of medications. They include:
Anticonvulsants: These medications were developed to control seizures, but they can also help reduce the pain of postherpetic neuralgia. Examples are:
Talk to your doctor or pharmacist about side effects of any new prescription or over-the-counter medication.
What Are The Best Over
As mentioned above, antiviral medications are prescription medications. Therefore, over-the-counter creams do not provide any antiviral activity, but they primarily work to relieve redness, pain, and itching symptoms. Topical creams containing lidocaine, capsaicin, or calamine may be helpful. Alternative treatments that can be topically applied include witch hazel cream, essential oils, manuka or clover honey, and chlorophyll. It is advised that you check with your doctor to make sure that these will not interact negatively with your existing medication before applying them.
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Knowing What To Watch For And Getting Vaccinated May Prevent This Painful Condition From Recurring
Shingles is a painful condition caused by the varicella-zoster virus, the same virus that causes the chickenpox. After a person has chickenpox, the virus stays in the nerve tissue near the spinal cord and brain. For reasons that are not fully understood, years later, the virus may reactivate and cause shingles.
Shingles often causes a rash, which usually develops on one side of the body. The rash forms blisters that scab over in a 7 to 10 days. However, some people dont develop these telltale symptoms. It doesnt always have a rash. And it isnt always on one side of the body. Those are two reasons shingles can be delayed in its diagnosis and treatment, says Houman Danesh, MD, director of Integrative Pain Management for Mount Sinai Hospital in New York.
Shingles pain can feel like burning or tingling. Some people describe it as being like ants crawling on their skin, Dr. Danesh says. The pain can last for up to four months.
According to the US Centers for Disease Control and Prevention , almost one out of every three people in the United States will develop shingles in their lifetime. There are an estimated 1 million cases of shingles each year in the United States.
Not everyone who had chickenpox will develop shingles. Those individuals with lowered immunity to infections are at increased risk. Shingles is also more common in older adultsabout half of all cases occur in men and women age 60 or over.
Early Treatment Is Key
Preventing Shingles Through a Vaccine
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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What Are The Complications Of Shingles
The most common complication of shingles is long-term nerve pain called postherpetic neuralgia. Long term nerve pain occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain can be very severe and can interfere with daily life. Read more about pain after shingles.Shingles on the face may lead to complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia , hearing problems, or brain inflammation .
Should I See A Doctor
It is usually worth seeing a doctor to be certain about the diagnosis and to see if you need treatment or not. Ideally you should see a doctor as soon as possible after the rash appears.
The rash of shingles can be very painful. So even if the doctor doesnât think you need an anti-shingles medicine, they may be able to give you stronger painkillers than those you can buy over the counter from the chemist.
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Are There Other Ways To Ease The Pain
Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include:
TENS : You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.
Cold packs: Try a gel-filled one to numb the area unless cooler objects make your neuralgia worse.
Comfortable clothes: Go for looser fits and fabrics such as cotton and silk.
Natural Remedies To Relieve Shingles Pain Outbreaks
Shingles pain can be excruciating. Thankfully, most people who experience a shingles outbreak only do so one time. However, others have recurrences. There is no cure for shingles, but there are antiviral medications that can speed the healing process. Shingles vaccination also is available to adults aged 50 and older to help prevent initial outbreaks among those at the highest risk for them.
Modern medicine is not the only solution for treating shingles pain and preventing future outbreaks. Naturopaths and doctors agree that natural treatments for shingles can help with both discomfort and relapses. If youre among the people who prefer natural alternatives for treating common conditions, this article provides information on the most effective natural treatments for shingles.
What Causes Shingles?
Shingles is a viral infection caused by the varicella zoster virus . It is the same virus that causes chickenpox. Individuals who recover from chickenpox can have the virus lay dormant in their systems for years. Doctors dont know why, but roughly 1 out of every 3 people who had chickenpox later have the virus reactivate as shingles.
How Common is Shingles?
For 1 out of 10 people, nerve pain postherpetic neuralgia can last for months or even years after the initial outbreak. It is one of the most common shingles complications. Age increases the risk of developing postherpetic neuralgia.
Can You Get Shingles More Than Once?
Doctor Recommendations for Shingles
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