What To Do If You Think You Have Shingles
If you suspect that you have shingles, its important to visit a healthcare professional as soon as possible. According to the American Academy of Dermatology , treating shingles within the first 72 hours gives you the best chance of minimizing complications like nerve pain.
Antiviral medications or other medications only available by prescription can shorten the duration of your shingles or lessen the severity.
If a cream or other topical isnt reducing your pain, its a good idea to visit your doctor again. They may recommend trying another treatment like capsaicin cream instead of lidocaine.
If a product is making your symptoms worse, its important to stop taking it right away.
You may be able to reduce your symptoms using home remedies while youre waiting to see a healthcare professional. These include applying a wet cold compress or taking a cool bath.
How Do You Treat Postherpetic Neuralgia Caused By Shingles
Peter J. Dyck, MD, FAAN, responds:
No cure exists for postherpetic neuralgia caused by shingles, but treatments are available, and for most people the condition resolves or improves with time.
Viral Culprit
Postherpetic neuralgia is a complication of shingles, an infection caused by the herpes zoster virus, which also causes chickenpox. After a childhood case of chickenpox, the virus can remain dormant for years. If it becomes reactivated in adults, it can cause shingles. Postherpetic neuralgia can result from nerve damage that affects the nerve cells, and can cause pain for weeks, months, or, occasionally, years.
Risk Factors
Certain factors such as older age , genetics, having diabetes or an especially severe case of shingles, a compromised immune system, or an infection can increase the risk of postherpetic neuralgia. The debilitating pain can also cause fatigue, insomnia, poor appetite, and poor concentration.
Vaccine Option
The US Food and Drug Administration has approved a shingles vaccine that can reduce the chance of getting both shingles and postherpetic neuralgia, or reduce the severity if an outbreak does occur. The vaccine is approved for people 50 and older but insurance may not cover the cost until you turn 60. Additionally, a new vaccine may be approved in the coming years that has proved more effective in phase 3 trials than the current vaccine.
Available Treatments
Reducing Nerve Pain From Shingles
Pharmaceuticals and vaccination for herpes zoster.
Shingles is virtually synonymous with pain, whether it be from the rash itself, from postherpetic neuralgia , or postherpetic itch . Additionally, it can lead to serious complications involving the eye, including vision loss and blindness, as well as pneumonia, hearing problems, brain inflammation, and even death.
Treatment of the virus typically begins with antiviralsand the sooner the better. Acyclovir, valacyclovir, and famciclovir are most commonly used to treat shingles. They should be administered as quickly as possible after the onset of symptoms to shorten the severity and length of the illness.
Additionally, there are simple self-care steps that can be followed to help reduce the pain and discomfort of shingles.
Long-term nerve pain from PHN is the most common complication of shingles and is experienced by up to 20% of patients with shingles The risk of PHN increases with age, as does the severity and length of pain, which can persist for months or even years.
The FDA has approved the use of analgesics, anticonvulsants, and lidocaine and capsaicin topical patches for treating PHN.
PHI, which can occur in conjunction with PHN, is caused by sensory fibers in the nerves that were damaged or died during the shingles infection. The remaining isolated nerve fibers fire when they shouldn’t, generating false sensations that fool the central nervous system.
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Can I Give Shingles To Others
No one can catch shingles from you. But the virus can be spread to a person who has never had chickenpox. The virus lives in the blisters that shingles causes. It can be spread until the blisters are completely healed. If you have blisters that have not crusted over yet, you should stay away from:
- Anyone who has never had chickenpox
- Babies under 12 months old
- Very sick people
Tell your doctor if you live with children who have not had chickenpox. They may need to be vaccinated.
How Long Does Postherpetic Neuralgia Last And How To Treat It
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Postherpetic neuralgia is a chronic complication of herpes zoster , which affects the nerves. Herpes zoster results from reactivation of dormant viruses in the sensory ganglion and is manifested by acute, painful vesicular rash over a single dermatome . The varicella-zoster virus is a nerve virus that gains access to neurons during a childhood infection of chickenpox . More than 95% of young adults are seropositive for VZV, and the incidence rate is 3.4 cases per 1,000 persons.
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What Will I Experience During The Procedure
The pain specialist will administer a local anesthetic before injecting the nerve block.
This procedure involves inserting a thin needle directly into the area where the nerves are located. The doctor may also use imaging aids so they can administer the nerve block as efficiently and quickly as possible.
You will feel a âpinchâ and a minor discomfort when the needle enters your skin. However, normally the fear of the procedure is worse than the procedure itself. The level of discomfort depends on how deep the needle is inserted.
What Organs Can Be Affected By Shingles
Body systems that can be affected include the eyes, nervous system, lungs, liver, and brain. Internal shingles can cause symptoms such as persistent pain, fever, cough, abdominal pain, and headache. When shingles affects internal organs, its a serious complication that requires urgent medical attention.
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How Can Nerve Blocks Alleviate Shingles Pain
Non-surgical nerve blocks act by stopping the nerves from sending pain signals to the brain. They donât treat the underlying causes of shingles but they do help ease the pain and even prevent PHN before it occurs, by numbing the affected area.
Nerve blocks are a safe shingles pain treatment option. It allows patients to go back to their normal life and to the activities that they enjoy.
How Is Nerve Pain Diagnosed
The main way your doctor will diagnose nerve pain is by listening to you and examining you.
In the examination, they will probably test your nerves by testing the strength of your muscles, checking your reflexes, and by seeing how sensitive it is to touch.
You may be asked to have tests like:
- blood tests to check your general health and look for underlying conditions
- nerve conduction studies which measure how quickly your nerves carry electrical signals
- a CT scan or an MRI scan to look for anything that could be pressing on a nerve
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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.
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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Why Does The Pain Persist In Some People
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.
Higher Intensity Of Pain With Internal Shingles
While both regular shingles and internal shingles can cause preherpetic neuralgia, this condition has been found to be more severe in the latter case.
One study found that at the onset of symptoms, after one month, and after three months, internal shingles patients had consistently more severe and persistent pain. Overall, however, preherpetic neuralgia occurs much more frequently in regular herpes zoster patients.
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How Postherpetic Neuralgia Is Treated
Many effective treatments are used to treat PHN, including medications, physical therapy, exercise, and a range of alternative therapies. There is no one approach to treatment that will work for everyone. A combination of treatments often is needed to reduce pain.
Medications
Your doctor may first recommend drugs you can get at the drugstore without a prescription, such as acetaminophen , or non-steroidal anti-inflammatory drugs . Capsaicin creammade from hot chili pepper seedsis also something you may want to try. When applied to the affected skin it may help reduce PHN-related pain. All of these treatments may cause side effects, including the capsaicin cream, so it is important to talk to your doctor about the correct way of using them.
If these medications arent strong enough to treat your PHN symptoms, your doctor may suggest some of the following prescription medications:
- Tricyclic antidepressants: These include drugs such as amitriptyline , nortriptyline , and desipramine these drugs take a few weeks to start working.
- Anticonvulsants: These drugs include gabapentin , carbamazepine , and pregabalin .
- Antivirals: These drugs include valacyclovir and acyclovir.
- Lidocaine patches: Placed on your skin, the lidocaine in the patches penetrate your skin and go to the nerves sending the pain signals.
- Capsaicin patches : These prescription patches contain very high concentrations of capsaicin and is applied in the doctors office for one hour every three months.
Why Shingles Can Be Painful
Before we walk you through treatment options, lets look at why this virus can cause pain. The varicella zoster virus develops a latency after chickenpox in these nerves called dorsal root ganglia, explains Paul Auwaerter, M.D., clinical director of the division of infectious diseases at Johns Hopkins Medicine in Baltimore. What can happen is, for reasons that arent entirely clear, the virus can reactivate within a nerve. The virus then travels along that pathway to the skin, causing a painful rash. In serious cases, it can lead to lasting nerve damage called postherpetic neuralgia, or PHN.
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What Is An Intercostal Nerve Block
The intercostal nerves run along each rib from the spine in the back to the sternum in the chest. These nerves can become irritated, inflamed, or damaged, which can result in a band-like pain along the chest wall. An intercostal nerve block can relieve this pain and increase circulation in the area. During this procedure, a local anesthetic is injected near the nerves that supply the area in pain. The steroid helps to decrease inflammation in the specific location where it is most needed. The steroid may help the injury heal by reducing inflammation. It may provide permanent relief or a period of a few weeks/months of relief while the injury is healing.
Eutectic Mixture Of Local Anesthetics Cream
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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Being Vaccinated Against Shingles Is The Best Way To Prevent Postherpetic Neuralgia Lingering Pain From The Shingles Virus Heres What You Should Know About The Causes Symptoms And Treatments For This Painful Chronic Condition
Postherpetic neuralgia , also known as shingles, most commonly occurs as a rash on one side of the torso.
This is no ordinary rash but the itchy blisters arent even the worst part.
A painful condition known as postherpetic neuralgia is the horrible gift that keeps on giving for more than 10% of people who develop it following a bout of shingles.
Oh yeah and the pain? It can be significant. People familiar with the burning, relentless feeling of PHN have likened it to passing a kidney stone mothers have described it as pain worse than labor.
How Long Does Nerve Pain Last After Shingles
Only approximately 9-15% of patients who get shingles develop Postherpetic Neuralgia. For those few patients who develop PHN, the length of time that it lasts usually varies. The majority of PHN patients have discomfort that lasts one to two months. About one-third of Postherpetic Neuralgia patients have symptoms that last around three months, and about one-fifth have symptoms that last a year or longer. Researchers are unsure what triggers the herpes zoster virus to re-emerge even after years of lying dormant. The virus may be obtained during youth, but it does not flare into shingles until years down the line. When the pain of shingles lingers long after the rash heals, it is considered Postherpetic Neuralgia. The bout of shingles damages the nerves. This means that the nerve damage caused by shingles affects a fully functioning nervous system. The damaged nerve will send random pain signals to the brain, which thereby causes a burning, throbbing sensation. Over time, the nerves of the skin calm, but due to the existing nerve damage, the pain can persist for years, even for the rest of the persons lifetime.
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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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What Neck And Back Pain Feels Like
Lower pain in the back may appear all of a sudden or create gradually.
It is not uncommon for soreness to happen after a particular occasion, such as flexing down to choose something up. It is not constantly possible to establish the factor for your soreness.
Sciatica is a form of back ache that radiates from all-time low to the back of the legs .
It is possible to hear a pop when your back is stressed throughout an activity.
As you flex over, soreness is commonly worse as well as when you relax, it improves.
Other symptoms of lower back discomfort include:
Stiffness: It may be difficult to move or align your back. Getting up from a seated position may take a while, as well as you may really feel like you need to walk or stretch to relax. You might discover decreased variety of motion.
Pose Problems: Lots of people with neck and back pain find it hard to stand up directly. You might stand jagged or bent, with your upper body off to the side as opposed to straightened with your back. Your lower back might look flat as opposed to bent.
Muscle mass Convulsions: After an exertion, muscular tissues in the lower back can spasm or acquire frantically. Muscular tissue convulsions can cause rigorous pain as well as make it tough or difficult to stand, walk or relocate.
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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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How Is Shingles Prevented
The best protection against shingles is vaccination. Chickenpox vaccine should prevent you from getting the virus, and so decrease the risk of both chickenpox and shingles. Shingles vaccine reduces the risk of getting shingles and its complications you may still get shingles, but the symptoms are usually less severe and post-herpetic neuralgia is less likely. In New Zealand there are 2 brands of vaccines that protect against shingles Shingrix and Zostavax. These vaccines differ in the way they work, their cost and how they are given. Read more about the differences between Shingrix and Zostavax.
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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.