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.
Treatment Options For Nerve Damage From Shingles
The thing with shingles to be aware of is it’s important that symptoms are treated early. This can prevent the onset of chronic pain from the related postherpetic neuralgia. If you become depressed, depending on your medical history your doctor may prescribe antidepressants or therapy of some sort.
Other treatment options can include topical and local anesthetics or numbing agents, but the pain and inflammation can be extreme and there is no cure or long term clinical treatment options available. When shingles is on the face, along certain facial nerves, it can damage related delicate muscle underneath, as well, if left untreated – so get a medical diagnosis promptly.
Go With Gabapentin For Phn
If you do have the lasting nerve pain of PHN, some doctors will prescribe anti-seizure medications, including Neurontin or Lyrica . Even though they were developed as anti-seizure medicines, they can help modulate the nerve pain until the nerves can heal, Dr. Auwaerter explains. These treatments can reduce pain signaling from the nerves to the brain by calming your neurotransmitters for a short time. They are FDA-approved as an effective treatment for PHN. Like antivirals, they require frequent daily dosing, usually three times per day.
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How Can This Pain Be Managed
If your doctor is able to identify an underlying cause for the neuropathic pain, treating it may reduce and even eliminate the pain.
For example, diabetes is a common cause of neuropathic pain. Proper diabetes care which includes a healthy diet and regular exercise may eliminate or reduce neuropathic pain.
Taking care of blood sugar levels can also prevent worsening pain and numbness.
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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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.
Finally Use A Cool Water Compresses
Cool water may soothe the burning sensation from both your rash and mild PHN pain. Depending on the location, you could potentially put a cool pack on it, Dr. Kotton says, though she notes this wont help much for severe pain. Soak a cloth in ice water, take it out, and apply directly to the affected area. Ahhhhh. Another soother to consider? This pain very likely won’t last forever, even if you have PHN. In the meantime, though, these tips will help you get through the worst of it.
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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.
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
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Wet Compresses Soaks And Calamine Lotion
A person can apply a clean, damp, and cool washcloth to their rash several times a day for 510 minutes each time. Alternatively, people can also try bathing in cool water with added baking soda, uncooked oatmeal, or colloidal oatmeal.
Individuals may also consider using calamine lotion as it may provide a soothing and cooling effect on the skin. A person can gently apply the lotion after the shingles blisters have scabbed over.
Think About Your Needs
What else should you consider?
- Potency. Start with a less potent product if youre new to CBD. However, if youre trying CBD for chronic pain, a higher potency product may be more helpful.
- CBD type.Isolates are a great option if youre interested in steering clear of THC and other cannabinoids. Broad-spectrum CBD provides the benefits of other cannabinoids but is THC-free. Full-spectrum products contain all the terpenes, cannabinoids, and flavonoids from the cannabis plant, including tiny amounts of THC no more than 0.3 percent. You will want to choose a pure isolate of CBD product to reduce the risk of testing positive for cannabis during any lab tests.
- Topical or oral. You might consider a topical oil or cream to apply to the shingles rash directly. This is ideal for people who do not want to take an oral form of CBD.
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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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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.
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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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What Is Shingles How Do You Get It
Shingles, also known as herpes zoster, is an infection of the nerve roots caused by the varicella-zoster virus .
You may have already heard of varicella-zoster since it is the virus that causes chickenpox. Its important to note that this is not a coincidence: shingles is not caught like many viral infections. Instead, VZV lies dormant in the body after someone gets chickenpox or the chickenpox vaccine.
At some point, the dormant virus can reactivate and lead to shingles.
Scientists arent currently sure why or how VZV suddenly causes problems. What we do know is that people with weakened immune systems are at greater risk.
Because of this, seniors are more likely to experience shingles. Other groups with a higher risk include those with medical conditions which negatively impact their immune systems and those who receive immunosuppressive drugs.
People cannot spread shingles itself, though they can spread varicella-zoster through direct contact with fluid from the shingles rash blisters.
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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.
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.
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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.
What Are The Risk Factors For Postherpetic Neuralgia
Age is a high-risk factor for postherpetic neuralgia. The older a person is when shingles develops, the more likely it is that the individual will develop postherpetic neuralgia. People over 60 years of age have about a 60% chance, while people 70 or older have about a 75% chance, of developing postherpetic neuralgia after getting shingles.
People with a family history of close relatives who developed postherpetic neuralgia are at a higher risk of developing this painful condition.
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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
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.
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 To Contact A Doctor
A person with symptoms of shingles should contact their doctor as soon as possible to discuss treatment options. If they experience ongoing painful symptoms, such as PHN, they can ask their doctor about pain relief options, such as acupuncture.
If acupuncture does not relieve shingles pain or makes it worse, it is advisable for a person to stop acupuncture treatment and contact their doctor for alternative options.
When To See A Doctor
Chronic intercostal neuralgia can greatly impact a persons quality of life.
The condition can be extremely uncomfortable. Chronic pain from intercostal neuralgia can also lead to reduced movement and poor sleep quality. It can also make it difficult for a person to breathe.
Also, intercostal neuralgia has some symptoms in common with other potentially serious health conditions. These include:
For this reason, it is important for anyone with prolonged or acute intercostal neuralgia to see a doctor immediately.
People should also see a doctor if they experience other symptoms of shingles.
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