Suffering from Shingles Pain?

If you've ever had shingles or known someone who has, you know that it's very painful and can be quite debilitating. Over 1/2 million people develop Shingles each year and some continue to have pain for weeks or months after their rash disappears. 

It's estimated that up to one-third of people with Shingles will continue to have pain, known as Shingles Pain or Post Herpetic Neuralgia, PHN that lingers for months or even years. Shingles Pain can be so severe that the person may not be able to tolerate a light breeze on their skin or be able to have clothes touch the part of their body that had the rash. 

Excruciating Pain

This pain changes people lives, it can be so overwhelming that people can't function. Many people describe the pain as an intense burning, almost as if their nerves are on fire. Until now, there hasn't been many good options to treat Shinlges Pain, however new medications are now available, including a long-acting form of gabapentin, (Gralise), nerve blocks and Pregabalin, Lyrica.

What causes Shingles

Shingles is caused by a reactivation of the herpes virus that causes Chicken Pox, which is known by several names including Herpes Zoster and Varicella. We know that as people get older and their immune systems weaken, that they are more likely to develop Shingles. 

We think that it gets reactivated from it's dormant or sleeping state when a person's immune system is depressed. People who are undergoing chemotherapy, who have cancer or who are over 55 are particularly susceptible. 

The virus attacks the nerves that lead from the spinal cord to the skin which causes the intense burning and pain. The virus "erupts" on the skin causing the blisters and sores. After the sores scab over, the pain can linger for weeks or months.

Shingles Vaccine

The CDC recommends that everyone over 60 get the Shingles Vaccine to help decrease the likelihood that they will have a reactivation of the virus and develop Shingles. Because I've seen too many people in their 50's develop Shingles, I recommend that anyone over 50 get the vaccine. In fact, the FDA approved the vaccine for people as young as 50. 

How to Recognize Shingles

• Pink, raised blisters or sores that start on ONE side of the body
• Pain in the same area 1 - 3 days prior to noticing the blisters
• The sores may look like bumps
• There may be a few or large clusters and look like an angry red rash
• Sores may be filled with pus after a few days, then scab over
• There may be intense burning, itching, tingling, deep pain or even muscle aches in the area
• Extreme sensitivity on the rash, so that even clothing may be too uncomfortable to wear
• Long lasting pain for weeks or months after the sores disappear

Treatment

As soon as you suspect Shingles, see a health care provider. The sooner it's treated, the better.

Anti-viral medications are essential to treat Shingles. Some providers say that if you don't start treatment within 72 hours it's not worth it to treat. I disagree, and recommend treatment as soon as possible, but never withhold treatment. This is based on studies that show that treatment at any time can significantly decrease the pain that follows Shingles.

The Anti-viral medications are safe and have no drug interactions. (Incredible but true, they only work on the virus, not other areas).

• Acyclovir - This is the first drug developed and the dose is 800 mg 4 times each day.
• Famciclovir - Famvir - The dosage is 500 mg 3 times each day.
• Valacyclovir - Valtrex - This medication achieves higher blood levels than Acyclovir, and has excellent results in decreasing the pain that accompanies Shingles. The dose is 1 gram 3 times each day. This is the medication that I use most often.

People with severe kidney disease will need to have dosage adjustments for these anti-virals.

What You Can Do

• Try not to scratch the sores
• It's ok to use an anti-itch cream like Benadryl or Caladryl
• Check with your provider about an oral Benadryl tablet to help with the itching
• Try cold soaks on the rash
• Wear loose clothing

What about the severe pain?

There are many people who have severe, debilitating pain with Shingles. Many people are being given narcotics for this pain, however these medications can leave people drowsy, un-focused and feeling fuzzy. In addition, narcotic pain medication can cause constipation.

There is a new non-narcotic medication that's been approved by the FDA to treat Shingles Pain, Gralise. This can be taken just once a day because it's a long-acting form of gabapentin, a medication that's been used for over a decade to treat pain. Though we don't know exactly how it works to reduce the nerve pain, we do know that it works.

A patient who I saw last week was able to wean off the narcotics that she has been taking 4 times each day for over a month by taking the long-acting form of gabapentin, Gralise for her nerve pain.

Disclosure: After my grandmother had Shingles, I realized how devastating and debilitating the pain that people experience. After I read the research on Gralise and talked to patients who were able to function again, I started working to help educate people about how to get more pain relief.