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
What Are The Pain Complications Of Shingles
Many sufferers have described the pain as extremely severe, and some even require narcotic pain-relief medications.
A blistering rash usually accompanies the outbreak. New blisters continue to appear for several days, and the entire outbreak can take weeks to heal. Blisters may cover the entire path of the affected nerve, or the involvement may be patchy. Involvement of the eyes during a shingles outbreak can be particularly serious, since scarring of the cornea and permanent vision loss can result.
Another debilitating complication of shingles is known as postherpetic neuralgia. In postherpetic neuralgia, the pain of shingles persists even after the rash has healed. The diagnosis is made when pain lasts for over 30 days after an outbreak. This pain can last for weeks, months, or even years. Up to 15% of people with shingles have this persistent pain, and it is not understood why the pain persists in some people, but it is likely that some type of nerve damage or inflammation occurs during the outbreak that leads to continued pain.
What If I Have Shingles And A Poor Immune System
If you have a poor immune system and develop shingles then see your doctor straightaway. You will normally be given antiviral medication whatever your age and will be monitored for complications. People with a poor immune system include:
- People taking high-dose steroids. per day for more than one week in the previous three months. Or, children who have taken steroids within the previous three months, equivalent to prednisolone 2 mg/kg per day for at least one week, or 1 mg/kg per day for one month.)
- People on lower doses of steroids in combination with other immunosuppressant medicines.
- People taking anti-arthritis medications which can affect the bone marrow.
- People being treated with chemotherapy or generalised radiotherapy, or who have had these treatments within the previous six months.
- People who have had an organ transplant and are on immunosuppressive treatment.
- People who have had a bone marrow transplant and who are still immunosuppressed.
- People with an impaired immune system.
- People who are immunosuppressed with HIV infection.
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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.
Treat Your Body And Mind
You can get worn down mentally when youâre in constant pain. Stress can make it seem even worse. Self-care starts with treating your rash, but donât stop there. Your mind and emotional state need to be cared for as well.
5. Stick with good habits: Your bodyâs working hard to fight the varicella-zoster virus that causes shingles. To give it the right support, you can:
- Eat nutritious food and have regular meals. Ask someone to make a run to the grocery store for fresh fruit and such if youâre not up for it.
- Try to get a good nightâs sleep and rest anytime you need to.
- Do gentle exercises, such as walking or stretching. Light activity can help take your mind off the pain. Keep it simple though, and check with your doctor if youâre trying something new.
6. Distract yourself: Sometimes, the best thing you can do is to put your focus elsewhere. Here are a few things to try:
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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.
Can You Do Regular Activities With Shingles
Whether or not you can continue with your regular activities while dealing with an active shingles infection depends on how you feel and whether youre still contagious.
Some people experience minor symptoms, while others have severe pain, itching, burning, and widespread, fluid-filled blisters for several weeks.
If your rash is oozing, you can spread shingles to other people. If the rash hasnt scabbed over yet, and its in an area that cant be covered, consider:
- staying home from work, school, or other daily activities where you interact with others
- avoiding contact sports and swimming
- not sharing towels, blankets, or clothes without washing them first
Additionally, shingles can cause flu-like symptoms like fever, headache, and upset stomach, which can derail your regular daily activities.
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When Should I Get The Shingles Vaccine
The current shingles vaccine is a safe, easy, and more effective way to prevent shingles than the previous vaccine. In fact, it is over 90% effective at preventing shingles. Most adults age 50 and older should get vaccinated with the shingles vaccine, which is given in two doses. You can get the shingles vaccine at your doctors office and at some pharmacies.
You should get the shingles vaccine if you:
- Have already had chickenpox, the chickenpox vaccine, or shingles
- Received the prior shingles vaccine called Zostavax
- Dont remember having had chickenpox
Medicare Part D and private health insurance plans may cover some or all of the cost. Check with Medicare or your health plan to find out if it is covered.
You should not get vaccinated if you:
- Currently have shingles
- Are sick or have a fever
- Had an allergic reaction to a previous dose of the shingles vaccine
If you are unsure about the above criteria or have other health concerns, talk with your doctor before getting the vaccine.
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.
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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
What Increases The Risk Of Long
The risk of developing post-herpetic neuralgia increases with age. Four weeks after getting shingles,
- 27% of 55- to 59-year-olds and
- 73% of over 70-year-olds had nerve pain.
Women seem to be more likely to have longer-lasting nerve pain than men. Post-herpetic neuralgia is also more likely to develop if your eyes were affected by shingles.
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Can Other People Catch Shingles
This one is confusing! You can catch chickenpox from other people, but you can’t catch shingles from other people. You only get shingles from a reactivation of your own chickenpox infection in the past.
So if you have shingles, and you come into contact with somebody else, they cannot ‘catch’ your shingles. But if they have never had chickenpox, it is possible that they could catch chickenpox from you.
To put it another way, no, you don’t ‘catch’ shingles. It comes from a virus hiding out in your own body, not from someone else. But if you have shingles, you may be infectious, as it is possible for people to catch chickenpox from you.
Only people who have never had chickenpox are likely to be at risk of catching chickenpox from your shingles. People who have had chickenpox should be immune from catching it again. If the rash is in a covered area of skin, the risk of anyone with whom you are not in close contact catching chickenpox is very low.
Preventing Nerve Pain After Shingles
But if you’re worried about PHN, don’t despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: famciclovir , valacyclovir , and acyclovir . These medications need to be started within two to three days of the onset of shingles.
“If you look at the clinical trials with any of these drugs in people over 50,” says Dworkin, “they cut the rate of pain at six months in half. That’s a very significant improvement.” They are also very safe and have few side effects, he says.
But who needs the drugs? Dworkin says there’s not a clear consensus yet.
There are some obvious cases. “I think everyone would agree that someone who is over 50 and has severe symptoms should get preventative treatment,” he tells WebMD.
But for younger people or those with fewer risk factors, the course is less clear.
“Some people think that everyone who gets shingles should get preventative treatment with antiviral medicines, because the medicines are so safe and have such few side effects,” he says.
Others argue that preventative treatment should only be given to those at greater risk. The main reason for this, Dworkin says, is cost.
“A full course of treatment could cost anywhere between $100 and $160,” he says. “That can add up, and insurance companies might not want to pay if the risks are very, very low.”
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Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
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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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.
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
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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 .
When To Seek Medical Advice
Shingles is not usually serious, but you should see your GP as soon as possible if you recognise the symptoms. Early treatment may help reduce the severity of your symptoms and the risk of developing complications.
You should also see your GP if you are pregnant or have a weakened immune system and you think you have been exposed to someone with chickenpox or shingles and haven’t had chickenpox before.
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Am I At Risk For Shingles
Everyone who has had chickenpox is at risk for developing shingles. Researchers do not fully understand what makes the virus become active and cause shingles. But some things make it more likely:
- Older age. The risk of developing shingles increases as you age. About half of all shingles cases are in adults age 60 or older. The chance of getting shingles becomes much greater by age 70.
- Trouble fighting infections. Your immune system is the part of your body that responds to infections. Age can affect your immune system. So can HIV, cancer, cancer treatments, too much sun, and organ transplant drugs. Even stress or a cold can weaken your immune system for a short time. These all can put you at risk for shingles.
Most people only have shingles one time. However, it is possible to have it more than once.
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 bodys 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 havent had chickenpox can catch that condition from you, the shingles itself isnt contagious.
For reasons that experts dont 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 wont.
We dont 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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