Treating Shingles And Postherpetic Neuralgia Pain
The term shingles is derived from the Latin and French words for belt or girdle, reflecting the distribution of the rash in usually a single broad band across one side of the body or body part. This band of pain and infection is only on one side of the body in the large majority of people and represents a dermatome, or origin of entry-- the area that a single sensory nerve supplies in the skin. The painful area may occupy part or all of the dermatome and the total distribution is notspecific to an area, but may blossom at the nerve endings of the dermatone and be a patch of infected nerve endings resulting in blisters. It is rare for shingles to affect more than one dermatone on one side of the body.
Shingles is caused by the varicella-zoster virus the same virus that causes chickenpox. Anyone who's had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie hidden for years. Eventually, it may reactivate and travel along nerve pathways to your skin producing shingles.
Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted disease. A person with shingles can pass the varicella-zoster virus to anyone who hasn't had chickenpox. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles.
Under certain circumstances, such as emotional stress, immune deficiency (from AIDS or chemotherapy), or with cancer, the virus reactivates and causes shingles. In most cases of shingles, however, a cause for the reactivation of the virus is never found. Anyone who has ever had chickenpox is at risk for the development of shingles. Today there exists a vaccination for those who have had chickenpox that may prevent shingles.
Shingles is more common in older adults and in people who have weak immune systems. It has been estimated that up to 1,000,000 cases of shingles occur each year in the U.S.
Treatments for shingles:
There are several effective treatments for shingles however the first course of action involves medications. Drugs that fight viruses (antivirals), such as acyclovir (Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir), can reduce the severity and duration of the rash if started early (within 72 hours of the appearance of the rash). In addition to antiviral medications, pain medications may be needed for symptom control. Both nonsteroidal anti-inflammatory medications and narcotic pain control medications may be used for pain management in shingles.
The diet may be supplemented with 1000 mgm. doses of L-Lysine and St. John's Wort has proven helpful. Nuts and pineapple should not be in the diet of anyone who has shingles.
Tens or interferential therapy can be applied to the affected area, but in most cases the pain from shingles is of short duration and tens therapy or interferential therapy is not indicated, unlike when the shingles pain persists and the patient has postherpetic neuralgia.
The affected area with shinglesshould be kept clean. Bathing is permitted, and the area can be cleansed with soap and water. Cool compresses and anti-itching lotions, such as calamine lotion, may also provide relief. Capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options should be discussed with your health-care professional.
What are shingles symptoms and signs? How long does shingles last?
Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. When the characteristic rash is not yet apparent, it may be difficult to determine the cause of the often severe pain. Shingles rash starts as small blisters on a red base, with new blisters continuing to form for three to five days. The blisters follow the path of individual nerves that come out of the spinal cord in a specific "ray-like" distribution (called a dermatomal pattern) and appear in a band-like pattern on an area of skin. The entire path of the affected nerve may be involved, or there may be areas in the distribution of the nerve with blisters and areas without blisters. Generally, only one nerve level is involved. In a rare case, more than one nerve will be involved. Eventually, the blisters pop, and the area starts to ooze. The affected areas will then crust over and heal. The duration of the outbreak may take three to four weeks from start to finish. On occasion, the pain will be present but the blisters may never appear. This can be a very confusing cause of local pain.
What is postherpetic neuralgia?
The most common complication of shingles is postherpetic neuralgia. This occurs when the nerve pain associated with shingles persists beyond one month, even after the rash is gone. It is a result of irritation of the nerves of sensation by the virus. The pain can be severe and debilitating. Postherpetic neuralgia occurs primarily in people over the age of 50 and affects 10%-15% of people with shingles. There is evidence that treating shingles with antiviral agents can reduce the duration and occurrence of postherpetic neuralgia.
The pain associated with postherpetic neuralgia can be severe and long lasting. Wind, temperature changes, perspiration can all be painful for the patient suffering from postherpetic neuralgia. For postherpetic neuralgia interferential therapy is indicated. Tens therapy can also be used but only after it has been ascertained the carryover pain relief effect of interferenital is not substantial enough to warrant interferential on an as needed basis rather than constant wearing of a tens unit.
Treatment For postherpetic neuralgia pain:
Electrode placement for tens and interferential is the same for both. Interferential therapy requires longer, strip type electodes due to the higher current being delivered. Both tens and interferential are at home, as needed treatments that are self administered when possible. The dermatone that was affected by the shingles is the treatment path for electrotherapy. For sake of discussion, on any tens or interferential unit, there are two electrodes per channel, two channels per unit. Each channel has one electrode that emits electricity and the other electrode is the ground or where the electricity from the first electrode travels to to be absorbed. One electrode sends electricity and the other removes the electricity from the body. This allows the targeting of the electrical stimulus to a specific area, ie. the dermatone.
One electrode, from channel 1, is placed directly beside the origin point where the dermatone exits the spinal chord. The other electrode for channel 1 is placed about 2/3rds of the way down the dermatone. What this accomplishes is from the origin point to 2/3 rds down the affected dermatone there is electrical stimulus.
On channel 2 one electrode is placed between the two electrodes approximately 1/3rd down, and the other electrode from channel 2 is placed at the distal end of the dermatone, or the end of the area where the patient is experiencing pain. This electrode placement now covers the entire dermatone from point of insertion to the farthest point on innervation with an electrical chemical stimulus and also affects the sensory nerve endings to stop or severely reduce the severity of the pain.
With interferential therapy the postherpetic neuralgia patient should feel immediate pain relief and have an extended carryover pain relief extending from hours to days, or possibly a week. At the point that carryover, residual pain relief is reaching a week the probability of continued pain should be diminishing completely.
About the author: Bob Johnson is owner/founder of MedFaxx, http://www.medfaxxinc.com, an ACHC accredited and Medicare approved provider of FDA approved electrotherapy devices used for pain management. The web site provides many educational videos for patients and physicians use to educate on the products and the science.
Frequently Asked Questions
How did I get shingles and how long will the blisters pain last?
I recently, last Saturday, was diagnosed with shingles. The pain is unbearable even with painkillers and that nerve dulling medicine. The blisters are killer and I can not take it anymore. How long does this pain last for? Also, I am the happiest kid in the world and I played tennis for like literally 24 hours the weekend prior to the diagnosis, however, I have done that plenty of times.
The pain can last quite a while - at least until the sores are well into the drying-up stage. Continue taking your medication as directed. Hopefully in about a week, it will be much better. Also, go to WebMd.com and type in shingles and read up on this condition and see if there are additional suggestions that you might do to make yourself more comfortable.
How long does the pain of shingles last after finishing acyclovir meds, begun immediately after rash appeared?
I'm a 51 year-old male. I saw a doctor, was diagnosed with shingles the same day that the rash appeared and began taking 800 mg of acyclovir 5X/day that same afternoon. The rash began to heal visibly within one week, but I still have some pain when my shirt touches the areas of the rash, and also some deep, lower back pain, especially late at night and when I first wake up. I've been taking Ibuprofen for the pain when necessary and the pain isn't as severe as it was the first ten days, but I'm wondering how much longer it may last. My doctor told me on the phone today (day # 11) that I am experiencing post herpetic neuralgia and that she could order shots of Vitamin B12 if the pain persists for another week. My research (on the WebMD site) tells me that post herpetic neuralgia is what occurs when you either a.) don't seek treatment and begin anti-viral meds for shingles within 72 hours of onset, or b.) your body doesn't respond to the medication. Is it possible for my doctor to know whether I have post herpetic neuralgia without examining me in person? (The doctor did NOT see me today, we only talked on the phone.) And can I expect the pain to go away completely reasonably soon?
In the majority of cases post herpetic neuralgia slowly improves, but can take up to five years and is occasionally on on-going problem. The history is usually sufficient to diagnose PHN - there is usually nothing to see by this stage on the skin other than possibly healing vesicles or scars. I have never used B12 for PHN - perhaps your GP knows something I don't - classic treatments include the antidepressant Amitryptilline, the anticonvulsant Gabapentin and its newer analogue Pregabalin. Some patients find Lidocaine infiltrated skin patches effective. Be careful with anti-inflammatories - always take with food and discontinue immediately if you see blood in stool or dark brown/black tarry stool. They can also cause problems with your kidneys. To be honest, PHN is difficult to treat and often requires patients to cycle through several drugs to find the most helpful agent, so I am a little surprised your GP has not asked to see you sooner in order to help you get relief. Antivirals reduce risk of PHN but unfortunately don't reduce risk to zero. Hope this helps and that you feel better soon.
How long does pain from Shingles normally last?
I woke up with a rash out of nowhere and went to the Dr that night....within 24hours of seeing any signs of the rash. The Dr said it was a case of shingles and gave me Percocet (oxycodone) as well as Zovirax (Acyclovir).
Its a week later since Ive been to the Dr and just finished the Zovirax meds but my chest still burns or itches really bad at times. It looked like the rash started to go away but then a day or two ago it seemed to have gotten a little worse.
Either way, if I went and got meds the day I saw the rash start, how long should the pain stay around for?
This is crazy annoying...I just got an internship at my college shooting B-Roll and doing production help but I can hardly help them build or break down sets with the shingles...the pain is crazy...
Theskill - "stop being a baby and enjoy the pain"
Fuck off you childish little brat
My aunt has shingles, and has had it for the past few months. From what I can recall, it was a month until the pain (slightly) subsided. Unfortunately you will have to wait it out, however, I suggest refraining from stressful activities like the one you described because stress can make it a heck of a lot worse.
What helps her out besides the medication are hot, warm baths, calamine lotion, and cold compressions.
Take care, and I pray for your speedy recovery PM me if you need anything.