Shingles Transcript

Opening: This audio segment on shingles and postherpetic neuralgia is brought to you by The Resource Center of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City, and is made possible through a generous grant from The Mayday Fund.

WHAT TO DO ABOUT SHINGLES AND POSTHERPETIC NEURALGIA

If you've ever had shingles or postherpetic neuralgia, you know how painful they can be. Let's talk about what they are.

What Are Shingles and Postherpetic Neuralgia?

The medical term for shingles is acute herpes zoster. Shingles is a skin rash that appears on half of the body, in a band or belt-like shape. The rash is often on the chest. But it can be found on any part of the body. You can get it on your forehead or stomach. Shingles is usually very painful. The pain may start a few days before the rash appears. Most of the time, the pain slowly goes away over several weeks or months. For the most part, people with shingles have no pain or a little pain one year after the rash. If the pain does not go away, it is called postherpetic neuralgia. Only a small number of people get postherpetic neuralgia.

What Causes Shingles and Postherpetic Neuralgia?

Many people get chicken pox when they are children. Chicken pox is caused by a virus called varicella zoster. As the chicken pox heals, the varicella zoster virus "goes to sleep." It stays in your nerves near the spine. The virus can "wake up" and become active again when your immune system gets weak. Your immune system can get weak when you are stressed, like by an illness in the family, or as you get older. When the virus "wakes up," it starts to grow in the nerves, often causing pain. When the virus moves to the skin, the shingles rash appears.

Who Gets Shingles and Postherpetic Neuralgia?

The older you are, the more likely you are to get shingles. And the older you are when you get shingles, the greater chance you have of getting postherpetic neuralgia. Other things, like how bad the attack of shingles is and whether you get antiviral medication at the time of the rash, may also be important. Some studies say that people who do not cope well with stress and pain may have worse postherpetic neuralgia than others who cope better.

Postherpetic Pain

Postherpetic neuralgia is felt in the area of the rash. Patients use words like sharp, electric-like jabs, burning, throbbing, and aching to describe the pain. Patients might also have terrible itching in the painful area. Some patients have very tender skin, called allodynia. This can make even the touch of clothing unbearable. Some patients feel a "sagging of the muscles" which might be caused by damage to some nerves in the area of the shingles.

People with postherpetic neuralgia may become depressed, worried, and have trouble sleeping because of the pain. If this is happening to you, make sure you tell your doctor.

Treatment for Shingles

Most patients with shingles should take an antiviral medication like acyclovir, valacyclovir, or famciclovir. The sooner you start this medication, the more likely the virus will stop causing damage. Some studies have shown that shingles can be less painful and last for a shorter time if you take a steroid like prednisone. If the pain is severe, you should have access to a strong pain reliever, one containing an opioid or narcotic medicine. Sometimes, pain specialists inject medications, called local anesthetics, which numb or deaden the nerves.

Can You Prevent Postherpetic Neuralgia?

Unfortunately, no treatment has been found that stops all patients with shingles from getting postherpetic neuralgia. Antiviral drugs are probably helpful. Some doctors believe that nerve blocks help, but this has not been proven. Many patients ask their doctors about cures or treatments using herbs and other medicines. Patients should not expect any of these treatments to prevent postherpetic neuralgia.

Treatments for Postherpetic Neuralgia

There are no treatments that fix the nerve damage caused by shingles. The good news is that there are treatments for the pain of postherpetic neuralgia. You should work with your doctor to find the best drug or combination of drugs for you.

At the present time, drugs are the most common way of treating postherpetic neuralgia. The anticonvulsant gabapentin is often tried, and many other drugs, including antidepressants and other anticonvulsants, are also used. When pain is severe, many pain specialists will offer an opioid or narcotic on a long-term basis. A new treatment on the market is the topical lidocaine patch. It acts locally in the skin's damaged nerves.

Patients with postherpetic pain also may benefit from nondrug treatments. These include physical therapy and psychological therapy (like learning relaxation techniques).

We hope that this segment has provided you with some basic information about shingles and postherpetic neuralgia. Remember, with all the treatment options available, there's every reason to stay hopeful your problem can be helped.