When Chronic Pain Comes From The Nerves These Nerve Pain Medications Can Help When Added To Other Pain Relievers
For chronic muscle and joint pain, effective therapies include rest, ice and heat, anti-inflammatory medications, and time. Usually, the pain calms down and you feel better.
However, muscle and joints may be only part of the picture. For instance, pain can be coming primarily from irritated nerves, along with the injured and inflamed muscle or joint.
Often the discomfort is only arising from nerve pain. Typical signs of this “neuropathic” pain include sharp, stinging pain or pain that radiates from one part of the body to adjacent areas. One of the most common causes is diabetes, although it can also be brought on by injury, infection, and some medications.
“People say things like, ‘My knee hurts and I feel like it’s coming up to the middle of my thigh and down to my shin,” says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. “In those cases, the nerve may be involved.”
In neuropathic pain, the nerve that was the mere messenger of pain now becomes the actual source. Narcotic pain relievers don’t often help and even when they do, they should not be used as a long term solution. Fortunately there are other options. Certain drugs that were originally developed to treat depression and seizure disorders also damp down inappropriate or excessive pain signaling in the nerves.
‘how Can I Reduce Nerve Pain Caused By Shingles’: Dr Martin Scurr Answers Your Health Questions
I’ve had shingles for six weeks. It’s no longer contagious but is very painful. My doctor has prescribed medications but they all make me sick. Is there anything that can reduce the nerve pain?
Jenny Johnson, Chesterfield, Derbyshire
How miserable for you to be suffering still with nerve pain. But fortunately, it is treatable.
Long-term pain following shingles becomes more common with age, with more than 18 per cent of over-70s with shingles experiencing it.
Herpes zoster is caused when the virus that leads to chickenpox is reactivated. This can lie dormant in nerve tissue, typically in an area of nerves just outside the spinal cord, for many years following initial infection.
As well as causing a painful rash of blisters, the virus triggers severe inflammation where it is lurking and eventually scars the nerve tissue, causing ongoing pain in many cases.
Painkillers don’t work for shingles nerve pain. Instead, we usually prescribe the anticonvulsant drugs gabapentin and pregabalin, or a tricyclic antidepressant, says DR MARTIN SCURR
For the first 30 days, this is described as acute herpetic neuralgia — it can be severely distressing, preventing sleep. In many cases, including your own, the pain continues long after this . If it persists after four months, it’s known as post-herpetic neuralgia.
This can lead to symptoms related to touch, with some experiencing numbness in the area while others find the opposite, that even the lightest touch is extremely painful.
The Details: Here’s Where Postherpetic Neuralgia Gets Complicated
Postherpetic Neuralgia Causes
To help you understand how shingles can cause PHN, you need to know how you can get shingles. Shingles is caused by a viral infection called herpes zoster. The virus that causes herpes zoster is called the varicella-zoster virus, and it is the same virus that causes chicken pox in childhood. After a person recovers from chickenpox, the virus can enter the nervous system and remain dormant for many years. In some people, the virus will reactivate years later and produce shingles.4
Researchers aren’t exactly sure what triggers the herpes zoster virus to re-emerge after all those years, but they think it is related to age, illness, and stress.3 Shingles can be very painful, and when the virus reaches the skin, it can cause blistery rashes. These rashes usually heal in less than 3 months.
And this chain of events can lead to PHN. If the pain of shingles lingers longer than 3 months, you may have PHN.
During your bout with shingles, the virus you were fighting injured nerves in and around the skin where the rash and blisters once existed. As your immune system eventually suppressed the virus, your rash and blisters disappeared. You may have even felt less pain, and you assumed that you had won the battle with shingles.
How Long Does Postherpetic Neuralgia Last And How To Treat It
Postherpetic neuralgia is a chronic complication of herpes zoster , which affects the nerves. Herpes zoster results from reactivation of dormant viruses in the sensory ganglion and is manifested by acute, painful vesicular rash over a single dermatome . The varicella-zoster virus is a nerve virus that gains access to neurons during a childhood infection of chickenpox . More than 95% of young adults are seropositive for VZV, and the incidence rate is 3.4 cases per 1,000 persons.
Kims Postherpetic Neuralgia Symptoms: No Worse No Better
Back home, Kim’s symptoms did not improve much. She was unable to return to work because of the pain, problems with her vision, and the side-effects of the gabapentin, which caused memory problems. By mid-July—more than 4 months after the initial onset—she still had swelling in her eye, spots on her cornea, scabbing on her scalp, and a great deal of burning pain. “It was like someone had set an iron on my head and left it there,” she recalls. She describes her condition at this point as “kind of treading water—no worse, no better.”
Kim’s neuralgia created a lot of pain, but she had other problems as well, particularly with her vision. She was given eye drops, which she had to use every waking hour. These helped some, she says, but being in bright lights was almost unbearable.
The Empowered Patient’s Guide To Postherpetic Neuralgia
Being vaccinated against shingles is the best way to prevent postherpetic neuralgia , lingering pain from the shingles virus. Here’s what you should know about the causes, symptoms, and treatments for this painful chronic condition.
Postherpetic neuralgia , also known as shingles, most commonly occurs as a rash on one side of the torso.
This is no ordinary rash but the ithcy blisters aren’t even the worst part. A painful condition known as postherpetic neuralgia is the horrible gift that keeps on giving for more than 10% of people who develop it following a bout of shingles.
Oh yeah and the pain? It can be significant. People familiar with the burning, relentless feeling of PHN have likened it to passing a kidney stone; mothers have described it as pain “worse than labor”.
What Are The Risk Factors For Postherpetic Neuralgia
Age is a high-risk factor for postherpetic neuralgia. The older a person is when shingles develops, the more likely it is that the individual will develop postherpetic neuralgia. People over 60 years of age have about a 60% chance, while people 70 or older have about a 75% chance, of developing postherpetic neuralgia after getting shingles.
People with a family history of close relatives who developed postherpetic neuralgia are at a higher risk of developing this painful condition.
Can Shingles And Postherpetic Neuralgia Be Prevented
Shingles can only be prevented if you never have chickenpox, or if you have very good immunity against the chickenpox virus . Most people in the UK have chickenpox as a child. However, immunity to the chickenpox virus reduces as you become older.
There is a vaccine against the varicella-zoster virus which is now offered routinely to people in the UK aged 70-79 years. The efficacy of the vaccine declines with age and so it is not recommended for people aged 80 years or older. This vaccine is the most effective way of preventing the development of PHN. It is a very effective and safe vaccine.
Know Your Risk Of Getting Shingles And Complications
About 1 out of every 3 people in the United States will develop shingles during their lifetime.
If you’ve had chickenpox, you are at risk for shingles. More than 99% of Americans born before 1980 have had chickenpox, even if they don’t remember it.
Your risk of getting shingles and having serious complications increases as you get older.
About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
Shingles may lead to other serious complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia, hearing problems, brain inflammation or death.
What Are The Complications Of Postherpetic Neuralgia
PHN itself is a complication of shingles. A serious complication of PHN is addiction to pain medications. Some patients may have an inability to live a normal lifestyle because of constant pain, while others have sleep and activities limited or even prohibited by touching the affected area, including just having contact with their own clothing. Patients taking opioids may become very constipated. In a few cases of PHN, muscle weakness can be an additional complication.
Shingles: Postherpetic Neuralgia’s Stubborn Mother
PHN is triggered by shingles which is triggered by chicken pox. Some think of shingles as adult chicken pox and while it’s true both shingles and chicken pox are caused by varicella-zoster virus—a common infection of the nerves—that’s pretty much where the similarity ends.
If you had chicken pox as a kid the varicella-zoster virus has been residing in your body ever since. It didn’t leave when your chicken pox resolved. Instead, it took up residence and remained a low-maintenance tenant until either age, a weakened immune system, stress, or some sort of cruel combination transformed the varicella-zoster virus into the herpes virus causing shingles—a much more demanding occupant.
Shingles typically starts with a variety of sensations–burning, tingling, and itching. Within days a blistery rash appears, usually on one side of the body typically around the torso, and the sensations may get more severe and painful. Within weeks the rash disappears and with it, those sensations.
Shingles On The Face: Symptoms Treatments And More
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Shingles on the face
Shingles, or zoster, is a common infection that occurs due to a herpes virus.
Shingles is a rash that usually appears on one side of the chest and back. It can also develop on one side of the face and around the eye.
The condition can be very painful and can sometimes have long-term side effects. No cure for shingles is available, but early treatment can lower your risk of serious complications.
I Tried Everything For Shingles Heres What Worked
For the last 3 1/2 weeks, I’ve been suffering from shingles and postherpetic neuralgia. It is a terrible condition. There seem to be many cures and treatments for it that are either questionable, or in the case of Western medicine, have a potential for adverse side effects. Most people suffer from post-herpetic pain that can go on for weeks, months, or even years.
Shingles Complications Can Be Mercilessly Painful
Q. I’m 81, and nine months ago I developed pain on the left side of my face and neck that was so excruciating it made me scream. A doctor told me I had shingles that would last six to eight weeks. I was given Neurontin and Percocet and told to take them three times a day. The doctor stopped the Percocet, but I’m still on Neurontin and still in pain. What can I do?
–M.B., Austin, Minn.
A. Shingles, or herpes zoster, is a viral infection of the nerves. It is a reactivation of the dormant chicken pox virus, Varicella, so only those who have had chicken pox get shingles.
Shingles is common; more than 1 million North Americans have it at any one time, and it is seen more often in older adults. The symptoms begin with pain and itching in the skin along infected nerve pathways, usually on the trunk or face.
Shingles typically lasts two to six weeks, but the virus never leaves the body, so it may be reactivated even years later. Shingles returns in about 1 in 24 people.
The reason for reactivation is unknown in most cases, but the virus can be reactivated when the immune system is impaired by disease, such as with AIDS or lymphomas, or by certain drugs.
Antiviral drugs, such as famciclovir or valacyclovir, taken for seven days in a row, are helpful in treating shingles. But they do not eliminate the shingles virus.
Neurontin is an effective adjunctive treatment sometimes prescribed for seizures.
Is It Possible To Prevent Postherpetic Neuralgia
Zostavax, the herpes zoster vaccine , has been shown to significantly decrease the risk of shingles. The vaccine is approved by the Food and Drug Administration for adults age 50 and older, and is recommended for all adults 60 and older who aren’t allergic to the vaccine and who don’t take immune-suppressing medications.
People age 50 to 59 may want to talk to their doctor about the shingles vaccine, if they are having ongoing pain or skin issues or have a weakened immune system. The vaccination is not a guarantee that shingles will not occur; however, those who get the vaccine usually experience a shorter period of pain.
What Is The Prognosis For Postherpetic Neuralgia
For the majority of patients who develop PHN, the prognosis is good although they may have to take pain medications for about one to three months. For others, the prognosis is fair to poor if the pain is severe, lasts longer than three months, or markedly reduces their quality of life. PHN occasionally results in permanent nerve damage; however, the disease is not fatal.
The Emotional Toll Of Nerve Pain After Shingles
Researchers are not just looking at biological and neurological risk factors for PHN. Dworkin was also a co-author of a study looking at psychological risk factors, too. The results were published in the Journal of Pain in 2005.
“It certainly looks like psychological stress can be a potent risk factor for PHN,” Dworkin tells WebMD.
The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.
Dworkin says previous studies have already shown a connection between stress and shingles development.
“One study even found that the risk of developing PHN was higher in people who were living alone when they developed shingles than people living with others,” Dworkin says, perhaps indicating that social isolation increases the risks of PHN.
What Are The Symptoms Of Postherpetic Neuralgia
The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred. The most common areas are in a band around the trunk of the body, usually on one side. It may also occur on the face.
The pain associated with postherpetic neuralgia is varied. It can range from discomfort to very severe. The pain is often described as burning, stabbing, or gnawing.
Patients with the condition often can’t bear the slightest touch, even clothing on the affected skin can be painful. In some cases, the sensation may be in the form of either hypersensitivity or decreased sensation. It is rare, but patients may also experience muscle weakness, tremors, or paralysis if the nerves involved also control muscle movement.
What Else To Expect With Postherpetic Neuralgia
Not everyone with PHN will experience the same type of pain symptoms.Researchers found that patients with PHN report three major types of pain:
The length of time PHN lasts also varies. Many patients report symptoms lasting from one to three months, but some patints may experience symptoms up to a year or longer.6
Because you may have to live with a certain degree of pain and discomfort for many weeks or months if you have PHN, expect some effect on your daily living.
- Physical impacts: may include fatigue, weight loss, reduced mobility, physical inactivity, and insomnia.
- Psychological impacts: may include anxiety, emotional distress, depression, difficulty concentrating, and fear.
- Social impacts: may include withdrawing from social engagement, isolation, attending fewer social gatherings, loss of independence, change in social role.
- Functional impact: may include difficulty with daily tasks such as dressing, bathing, and eating, as well as activities such as cooking, shopping, and travelling.7
Soothe Blistering Skin With Aluminum Acetate
Now, for some topical relief: This OTC astringent powder is made to calm minor skin irritation such as poison ivy, bug bites, chicken pox, and other itchy rashes. It’s also called Burow’s solution or Domeboro solution, and it can be found at your local pharmacy or online. This won’t work for nerve pain, though, so don’t rely on it for anything more than minor itch relief . The American Academy of Family Physicians recommends soaking a cool compress in the solution and applying it to the affected area.
Thousands Could Be Spared Pain From Shingles
For many people, finding a cure for shingles pain is a never-ending search
The pain sufferers say, is unbearable.
“I had it on my face, and I have been to hell and back,” says one.
Another describes it as “sending me mad.” For a third: “Four years on and I’m still looking for some relief – does one ever get rid of shingles?”
Shingles affects a quarter of a million Britons every year, nearly half of whom will suffer dreadful long-term pain.
But according to a leading expert, prompt treatment with anti-viral drugs could prevent, or at least reduce, suffering. The problem is that patients aren’t receiving treatment soon enough.
The cause of the disease is a virus, known as herpes varicellazoster, which can lie dormant in the nervous system for years until triggered.
The Shingles Support Society says 40 per cent of sufferers will
have long-lasting pain due to permanent nerve damage.
The condition predominantly affects older people, among whom it is remarkably common: by the age of 85, 65 per cent of us will have suffered this excruciating disease – but younger people can suffer from it, too.
“Shingles can be really debilitating,” says Professor Steve Field, chair of the Royal College of General Practitioners.
“The problem is the long-term pain and damage it causes. It can affect your whole life.”
While the disease cannot be prevented, and there is no “cure,” Professor Field stresses the importance of early treatment with antiviral drugs.
Foods To Avoid When Suffering From Shingles
Health Check Certified By: Julie Ching, MS, RDN, CDE
Shingles is no fun at all for adults – it’s caused by the same virus that causes chicken pox, which can become dormant for years and reappear as this painful nerve condition. Those with shingles develop a very painful and itchy rash that can last for weeks or months.
There are some treatments available for shingles, and even vaccines to help prevent it, but one thing you can do to alleviate some of the symptoms is to change your diet. The best way to help relieve shingles and help speed up the recovery process is to avoid these 6 foods…
What Are The Pain Complications Of Shingles
Many sufferers have described the pain as extremely severe, and some even require narcotic pain-relief medications.
A blistering rash usually accompanies the outbreak. New blisters continue to appear for several days, and the entire outbreak can take weeks to heal. Blisters may cover the entire path of the affected nerve, or the involvement may be patchy. Involvement of the eyes during a shingles outbreak can be particularly serious, since scarring of the cornea and permanent vision loss can result.
Another debilitating complication of shingles is known as postherpetic neuralgia. In postherpetic neuralgia, the pain of shingles persists even after the rash has healed. The diagnosis is made when pain lasts for over 30 days after an outbreak. This pain can last for weeks, months, or even years. Up to 15% of people with shingles have this persistent pain, and it is not understood why the pain persists in some people, but it is likely that some type of nerve damage or inflammation occurs during the outbreak that leads to continued pain.
Spinal Cord Or Peripheral Nerve Stimulation
These devices offer a safe, efficient, and effective way to relieve many types of neuropathic pain conditions. Similar to TENS, they are implanted under the skin along the course of peripheral nerves. Before implantation, doctors do a trial run using a thin wire electrode to determine patient response.
The spinal cord stimulator is inserted through the skin into the epidural space over the spinal cord. The peripheral nerve stimulator is placed under the skin above a peripheral nerve. As soon as the electrodes are in place, they are switched on to administer a weak electrical current to the nerve.
Experts believe that by stimulating the non-painful sensory pathway, the electrical impulses trick the brain into “turning off” or “turning down” the painful signals, resulting in pain relief.
Symptoms are usually limited to the area of skin where the shingles outbreak first occurred and may include:
- occasional sharp burning, shooting, jabbing pain
- constant burning, throbbing, or aching pain
- extreme sensitivity to touch
- extreme sensitivity to temperature change
In rare cases, if the nerve also controls muscle movement, there may be muscle weakness or paralysis.
Symptoms may make it hard to carry out some daily activities, such as bathing or dressing. PHN may also cause fatigue and sleeping difficulties.
Antidepressants May Offer Surprising Relief
Antidepressants may have been “invented for depression, but they are also known to modulate peripheral nerves,” Dr. Auwaerter says, thereby dulling PHN pain. Your physician may suggest Pamelor or Aventyl or Elavil . Dr. Auwaerter adds that these medications can sometimes cause side effects like fatigue and sluggishness—though PHN patients usually only need a low dose, which is unlikely to cause major adverse effects.
What Are Possible Complications Of Shingles
Shingles often goes away with no lasting effects. But some people have complications during or after the infection comes out:
Postherpetic neuralgia. This is the most common complication. It’s more likely as people age, especially after age 60. It’ is nerve pain at the place where the rash used to be. It can range from mild to severe. It can last for only a few days, or for months or even years after you have had shingles. Antiviral medicines given during the first 72 hours of the rash can reduce the chance of postherpetic neuralgia. Other medicines can be prescribed to help ease the pain and improve quality of life.
Bacterial infection. Shingles blisters may get infected with bacteria. Depending on the severity of the infection, topical, oral or IV antibiotic medicine is used to treat the infection.
Eye problems. If you have shingles on the face, see your healthcare provider right away. Shingles can cause serious problems with vision, and even blindness.
In very rare cases, shingles can also lead to pneumonia, hearing problems, brain inflammation, or even death.
How Can I Make The Neuropathic Pain Go Away
Neuropathic pain occurs biochemically, making it a very fluid system that can often be quickly modified, resulting in pain relief. Many different chemicals in your body may be involved in your pain, and therefore it is worth trying different types of medications to see which ones work best in your case.
For many, treating the nutritional and thyroid deficiencies and eliminating the muscle spasms, which are compressing your nerves, may be enough to eliminate your pain. Others may need to take medications to suppress the pain while we look for ways to eliminate the underlying cause.
The best way to tell which chemicals are involved in your nerve pain is to simply try different medications to see what eases your pain. Basically, it is like trying on different shoes to see what fits best. The good news is that we have a large assortment of “shoes” that you can try on and that are likely to help you.
It is, of course, critical to begin by eliminating the underlying causes of neuropathy and giving the nerves what they need to heal. This includes the nutritional support we’ve discussed. In addition, the involvement of free radicals in nerve excitation was found in 1995, supporting the use of antioxidants in nerve pain. Since that time, the antioxidant lipoic acid has been shown to be helpful in diabetic neuropathy and should be tried in other neuropathies as well. You will be amazed at how much benefit you may get over time simply from optimizing nutritional support.