Your One-Stop Shingles Shop

Ok, I am only going to do this once, so pay attention.  Due to 20+ searches for shingles a day and several emails asking me about the same topic, I feel some sort of obligation to put some information out there.  If you fall into the 99.9% of people who don't give a shit about shingles, for christ's sake, spare yourself the torture of reading this.  If you are the .1% that comes to my site day after day looking for 24-hour shingles updates, it's your lucky fucking day.  But this is the first and last post on this subject.  I will not be defined by my shingles.

Note:  Although this is the longest blog post in the history of blogs, it is actually the abridged version.  Go here for more.

Overview

People who have had chickenpox (varicella zoster) in their youth can develop shingles (herpes zoster) in later years. During an acute attack of the chickenpox virus, most of the viral organisms are destroyed, but some survive, travel up nerve fibers along the spine, and lodge in nerve cells where they may lie dormant for many years. A decrease in the body's resistance can cause the virus to reawaken decades later. It then travels back down the nerve fibers to the skin's surface.

The reawakened virus generally causes a vague burning sensation or tingling over an area of skin. A painful rash usually occurs two to five days after the first symptoms appear. A cluster of small bumps (1) turns into blisters (2) that resemble chickenpox lesions. The blisters fill with pus, break open (3), crust over (4), and finally disappear. This process takes four to five weeks.

A painful condition called post-herpetic neuralgia can sometimes occur. This condition is thought to be caused by damage to the nerves (5), and can last from weeks to years after the rash disappears.

Controlling the Outbreak

Although viral diseases can't be cured, doctors can prescribe oral antiviral medications, such as Zovirax (acyclovir), Famvir (famciclovir) and Valtrex (valacyclovir), that help control the infection by hindering reproduction of the virus in the nerve cells. "Antiviral therapy may shorten the course of an episode of shingles," says Cvetkovich. "However, therapy must be started as early as possible after symptoms develop--within 48 hours--in order to have an effect."

To relieve pain, the doctor may recommend over-the-counter analgesics (pain-relieving drugs), such as ibuprofen and naproxen, or prescription drugs, such as indomethacin, all members of a class of medications known as nonsteroidal anti-inflammatory drugs. Acetaminophen is also commonly used to relieve the pain. If pain is severe, doctors may add stronger analgesics, such as codeine or oxycodone.

When the Pain Persists

In some patients, the misery continues long after the rash has healed. Many of the 1 million people who develop shingles each year experience a complication called post-herpetic neuralgia (PHN). This term refers to pain that is present in the affected area for months, or even years, afterward. Although the acute pain of shingles and the chronic pain of PHN (called neuropathic pain) both originate in the nerve cells, their duration and the reaction to treatment is different.

Pain that occurs with the initial outbreak responds to treatment and is limited in duration. In contrast, PHN lasts longer, is difficult to treat and can be incapacitating. Furthermore, for unknown reasons, older people suffer more from this debilitating pain than younger people. In many individuals, the skin is so sensitive that clothing or even a passing breeze cannot be tolerated on the affected area. Described by PHN sufferers as agonizing, excruciating, and burning, the pain can result in an inability to perform daily tasks of living, and lead to loss of independence and, ultimately, depression and isolation.

"I would rather have ten babies than the pain I've endured for the past ten years," says 87-year-old Etta Watson Zukerman of Bethesda, Md., who has lost partial use of her right arm and hand due to nerve damage from PHN. "Nothing my doctor prescribed helped. I even went to a sports medicine specialist who recommended exercises. They didn't help either." Many PHN sufferers receive no relief at all, no matter what medications or therapies they use. And what works for one doesn't necessarily work for another.

Treating the Pain

Doctors use other methods to alleviate pain with varying degrees of success. "One of the relatively new medications that I'm enthusiastic about is the Lidoderm patch," says Veronica Mitchell, M.D., director of the pain management center and inpatient pain service at Georgetown University Hospital, Washington, D.C. "It's the transdermal form of lidocaine and it's been studied in the PHN population with very good results," adds Mitchell. "We prescribed the Lidoderm patch for a patient who had intolerable side effects with oral medications--and no relief--and she's had about a 50 percent-plus improvement in pain relief. It's one of my first-line therapies." The medication contained in this soft, pliable patch penetrates the skin, reaching the damaged nerves just under the skin without being absorbed significantly into the bloodstream. This means that the patch can be used for long periods of time without serious side effects.

Yet another method used to treat PHN is transcutaneous electrical nerve stimulation, or TENS. A device that generates low-level pulses of electrical current is applied to the skin's surface, causing tingling sensations and offering some people pain relief. One theory as to how TENS works is that the electrical current stimulates production of endorphins, the body's natural painkillers.

TENS is not for everyone. "TENS didn't help at all," says Einar Raysor of Rockville, Md. "I found there was a problem in fine-tuning the administration of the electrical current. Low doses of the electrical current didn't do anything for me. When the technician increased the current, it gave me a painful response. After this happened a couple of times, we dropped the treatment."

As a last resort, invasive procedures called nerve blocks may be used to provide temporary relief. These procedures usually entail the injection of a local anesthetic into the area of the affected nerves. "We have controversial results in the terms of the efficacy of nerve blocks," says Mitchell. "I do consider nerve blocks in treating PHN and I would perform them because there's some evidence that they work, but the real efficacy is to catch and treat the patient in the acute shingles phase. As PHN presents mostly in the elderly, and the older patient often is unable to tolerate some of the medications we use, I find nerve blocks useful in these cases."

Injection directly into the spine is another option for relief of pain that is not easily treated. A Japanese clinical study published in the New England Journal of Medicine found that an injection of the steroid methylprednisone combined with the anesthetic lidocaine reduced pain by more than 70 percent in one patient group compared with groups that received lidocaine alone or an inactive substance.

Comments

[Noelle]

I had shingles when I was 13 years old. It sucked ass. The scars have faded, but it still hurts a little when I scratch an itch on my back where they used to be.

That's all the info I have to add. Pretty helpful, huh?

Sooooo, do you actually have shingles? Or does google think you're a dermatologist in disguise?

[Louise]

God I hope I never have to read this post for real.

So, if you posted a shingless infor guide, does this mean I should post something about growing bellies? Cause that seems to be all the traffic I am getting right now. Oh, and instructions for decorating pregnant bellies. WTF? Totally coming to the wrong place, my friends.

[Louise]

Whoa, I don't know WHAT my problem was, but you definately posted something other than a "shingless infor guide."

I blame cold fingers.