What Is The Best Way To Treat Pain Associated With Shingles
Dr. Anne Oaklander answers the question: ‘Best Way To Treat Shingles Pain?’
& #151 — Question: What Is The Best Way To Treat Pain Associated With Shingles?
Answer: Shingles is generally a painful condition. It’s a rash that eats through the skin.
For some patients, they’ll be able to manage without pain medications, particularly if they have only a mild rash. But many patients will need medications for pain management. Some people may find over the counter anti-inflammatory and pain relief is adequate, such as acetaminophen, aspirin, or ibuprofen. But substantial numbers of people will need prescribed pain medications by their physician. This should be discussed with your physician because everyone’s situation is difficult.
Some patients, in fact, with severe pain may require admission to the hospital and treatment with intravenous or intraspinous pain medications.
Most people will be able to manage in their homes with prescriptions for medication that may include percocet or vicodin or other similar pain relievers as well as medications aimed at the nerves. These include gabapentin, as well as tricyclic medications such as nortriptyline, desipramine, or amitriptyline.
Lasting Pain After Shingles
Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. Its still not clear how it can be prevented or what the best treatment is.
Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word “post-herpetic” means “post-herpes” because the pain arises after infection by the herpes zoster virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.
The main symptom of post-herpetic neuralgia is pain in the nerves . The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.
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.
Prevention
Avoiding Chronic Pain
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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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Spinal Cord Or Peripheral Nerve Stimulation
These are often used to treat several different types of neuropathic pain. Electrodes are placed underneath the skin along the affected peripheral nerves. Before using this technique, doctors will do a test using a wire electrode to get a sense of how the patient will respond.
After the electrodes have been placed above the peripheral nerve, a weak electrical current is sent to the nerve. By stimulating a sensory pathway that doesnt cause pain, experts believe that this electrical signal to the brain can trick the brain into turning off the painful signal, bringing relief to the patient.
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Avoid The Pain Of Shingles
Anyone who has recovered from chickenpox can develop shingles
Shingles is a painful infection. Some people have the virus hiding in their nerve tissue, and if conditions are right, the virus “awakens.” This may cause a few blisters on the skin or a big rash that is only on one side of the body. The rash may be on the chest and back, at the waist, on the upper arm, or the side of the face and scalp. In healthy people, the rash goes away in 2 to 4 weeks.
Shingles is not likely to spread, but it may cause chickenpox. The same virus that causes chickenpox causes shingles. However, not everyone who had chickenpox will develop shingles.
What are the risk factors for shingles?
Anyone who has had chickenpox can develop shingles. But your risk is greater if you:
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Are age 50 or older
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Have an illness that weakens your immune system, such as HIV infection
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Have cancer, especially leukemia or lymphoma
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Take medicines that suppress your immune system, such as steroids or those given after an organ transplant
Can shingles be prevented?
A vaccine reduces your risk of getting shingles. Half as many people get shingles after being vaccinated. Among those who are treated and then develop shingles, only one third develop after-shingles pain. If you’re older you when you’re vaccinated and you get shingles, your outbreak will be less severe.
How do you know when shingles is coming on?
What is the treatment for shingles?
What causes after-shingles pain?
How serious is after-shingles pain?
Liquid Dimethyl Sulfoxide And Idoxuridine
Idoxuridine is an antiviral medication approved in Europe for treating shingles.
One 2015 publication suggested frequent application of 5 to 40 percent idoxuridine dissolved in DMSO may speed up the healing time of shingles. However, in the United States, idoxuridine is only FDA-approved to treat keratitis, a herpes simplex virus infection of the cornea of your eye.
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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.
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.
Procedures
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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 .
Mayo Clinic Minute: Learn More About Eye Shingles
Shingles is caused by the varicella-zoster virus the same virus that causes chickenpox. If you’ve had chickenpox, the virus can lie dormant in your body’s nerve tissue for years when suddenly it’s triggered by stress or a weakened immune system, and manifests as shingles. A shingles vaccine called Shingrix is recommended for anyone over 50. It helps prevent the disease and reduces the severity of symptoms.
Ophthalmic shingles is one particular version of the disease that can have some serious side effects that ultimately can cause permanent damage to your vision.
Journalists: Broadcast-quality video is in the downloads at the end of this post. Please “Courtesy: Mayo Clinic News Network.” Read the script.
You’re probably familiar with shingles, a viral infection that causes a painful rash usually on the body’s torso. But did you know that shingles also can affect the eye?
“Shingles around the eye typically involves the skin of the forehead and the skin of the upper lid. It can also involve the side of the nose or the tip of the nose,” says Dr. Keith Baratz, a Mayo Clinic ophthalmologist.
The virus lies dormant for years, but, when triggered by stress or a weakened immune system, it travels along nerve pathways to the skin and usually affects only one side of the face.
“You can almost draw a line right down the middle of the forehead when you get the rash,” says Dr. Baratz.
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Shingles And Nerve Paths
Shingles is caused by a reactivation of the virus that causes chickenpox. Only people whove had chickenpox or chickenpox vaccines can develop shingles. Having a chickenpox vaccine can lead to shingles because the vaccine contains the virus that causes chickenpox.
Shingles isnt contagious, but people who have not had chickenpox can develop chickenpox if they come in contact with open blisters of somebody with shingles.
After your body fights off a chickenpox infection, the herpes zoster virus remains dormant in your cranial nerves and spinal ganglia until it becomes reactivated. Spinal ganglia are nerve cells that connect your spinal cord to nerves in your body and limbs.
The virus reactivates when your immune system is no longer able to suppress it. Reactivation most commonly occurs in older adults because the immune system tends to get weaker with age, as well as in people with suppressed immune systems.
Once the virus is active, it usually spreads down sensory nerve fibers that lead from your spinal cord to your skin. These nerves carry sensory information like feelings of pain, itchiness, or pressure from your skin to your spinal cord and brain.
Once the virus gets to the end of these sensory nerves, it reaches your skin and usually leads to a rash. This rash often shows up in one or two nearby areas of skin called dermatomes.
A dermatome is an area of your skin where the sensation is supplied by one spinal nerve.
What Everyone Should Know About The Shingles Vaccine
Shingles vaccination is the only way to protect against shingles and postherpetic neuralgia , the most common complication from shingles.
CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.
Your doctor or pharmacist can give you Shingrix as a shot in your upper arm.
Shingrix provides strong protection against shingles and PHN. In adults 50 years and older who have healthy immune systems, Shingrix is more than 90% effective at preventing shingles and PHN. Immunity stays strong for at least the first 7 years after vaccination. In adults with weakened immune systems, studies show that Shingrix is 68%-91% effective in preventing shingles, depending on the condition that affects the immune system.
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Help Is Available For Phn
Fortunately,early treatment for shingles can lower your chances of getting PHN.
For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.
Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.
However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.
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.
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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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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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.
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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.