ASK THE DOCTOR: Shingles pain can be treated
By DR. JIM MITTERANDO
The Patriot LedgerQ I recently had shingles and I am in quite a bit of pain. What can you recommend to treat the pain? I've heard that shingles is not contagious. Is this true?
A Shingles are painful blisters that result from an old chicken pox infection years before. After the chicken pox rash clears, the pox virus remains dormant in nerve roots and can re-emerge years later with painful blisters. The blisters do contain chicken pox virus, which could be contagious for anyone who has not had chicken pox or has not been vaccinated.
Most adults, however, have had chicken pox and do not have to worry because they are immune. To be safe, avoid touching the blisters until they have scabbed and are no longer contagious.
Coming in contact with someone who has shingles or chicken pox cannot cause you to develop shingles. Stress, illness and advanced age are triggers that can activate the dormant pox virus in the nerve roots causing shingles to erupt.
The blisters occur along the distribution of a nerve and only affect one side of the body. After several days, the blisters scab and crust. Despite the skin healing over the next week or two, the pain often persists for weeks or months.
The pain can be quite severe, which gives shingles its bad name. People over the age of 50 are more likely to develop prolonged nerve pain after shingles called postherpetic neuralgia.
Fortunately, antiviral medications such as Acyclovir (Zovirax), Famciclovir (Famvir) and Valacyclovir (Valtrex) can help to get rid of shingles and reduce the chance of postherpetic neuralgia in people over the age of 50. Studies found no benefits for younger people because they have less severe cases of shingles. Antiviral pills are well tolerated but are expensive.
In order for the antiviral medications to be effective, they must be started within the first three days of the blisters before they have had time to crust over. If you miss the opportunity to take an antiviral medication and you're otherwise healthy, your health care provider will likely advise you to let shingles run its course. Shingles heals with time - with or without treatment.
Sometimes, steroids such as Prednisone are also prescribed for treating shingles. The benefits of steroids are not as clear as the antiviral medications with mixed results in medical studies. Steroid side effects can include agitation, insomnia, upset stomach and increased appetite.
Antiviral medications do not treat the pain, so you should start with Acetaminophen (Tylenol) or Ibuprofen (Advil, Motrin) for the pain.
The addition of narcotic pain medication, such as Codeine, Hydrocodone (Vicodin) or Oxycodone (Percocet), is sometimes required. Unfortunately, narcotic medications can cause sedation and constipation; you cannot drive a car when taking this kind of pain medication.
Amitryptiline (Elavil), an old antidepressant medication, is used at lower doses to treat chronic nerve pain and insomnia. Side effects include sedation, feeling hungover the next morning, and dry mouth.
Capsaicin cream (Capsin, Zostrix), available over-the-counter, is derived from chili peppers. Capsaicin is the chemical in hot peppers that causes the tingling, burning sensation. Used on the skin, it can help with chronic nerve pain. Make sure the skin is healed with no open or scabbed wounds - otherwise the cream can cause discomfort.
The cream is applied at least three to four times a day and may not improve pain until several weeks of use. I recommend wearing latex gloves to apply the cream and hand washing after use in order to avoid getting the chemical in the eye that causes severe irritation and pain.
Neurontin (Gabapentin), a seizure medication, is commonly used for chronic pain and is often helpful with postherpetic neuralgia. The medication is well tolerated but is expensive and requires taking three times daily.
Other pain treatments include lidocaine skin patches (which temporarily numb the skin) and, rarely, nerve block injections.
The prolonged, severe pain following shingles often causes sleepless nights and depression. These problems should be treated as well.
Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.
Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.
Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.
Copyright The Patriot Ledger
Transmitted May 21, 2002