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.
Treatment For Lingering Shingles Pain
Most cases of shingles clear up within a month or so. After you have shingles, its unlikely that youll get it again. But as we mentioned above, some people develop PHN, a complication that follows shingles. Older people, women, and those who had more severe shingles symptoms seem to be at higher risk of developing PHN, but its not clear why others never develop it.
Nerve blocks are injections containing local anesthetic to numb nerves contributing to PHN pain. Other minimally invasive treatments include nerve ablation and steroid injections to treat inflammation related to shingles.
We offer several nonaddictive prescription medications for nerve pain. Oral antidepressants or membrane stabilizers can reduce symptoms of PHN. For some people, topical medication like capsaicin cream can temporarily relieve pain.
You dont have to turn to addictive opioid pain medications if you have shingles pain. Dr. Soin and our team are here to help you find relief with a personalized treatment plan, whether its nerve-blocking injections or medication.
If you still have nerve pain after shingles, you dont have to suffer in silence. in Centerville or Beavercreek, Ohio, or book an appointment online to learn more about the PHN treatment that could be right for you.
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Can I Give Shingles To Others
No one can catch shingles from you. But the virus can be spread to a person who has never had chickenpox. The virus lives in the blisters that shingles causes. It can be spread until the blisters are completely healed. If you have blisters that have not crusted over yet, you should stay away from:
- Anyone who has never had chickenpox
- Babies under 12 months old
- Pregnant women
- Very sick people
Tell your doctor if you live with children who have not had chickenpox. They may need to be vaccinated.
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Treatment Of Herpes Zoster
The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
What Can I Do Right Now
You can begin to help yourself right now to manage the challenges and stress of PHN by eating better, engaging in relaxation activities, improving your sleep, moving more, and maintaining social connection with others. Engaging in physical activity, even taking short daily walks, will help you feel better.
You also can help yourself by learning about pain and how it works in the body. Once you learn the large role played by the brain in how you experience pain, it can help you take more control over your pain and become less fearful of it. Understanding the Complexity of Chronic Pain, a 10-minute video, is another good resource.
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Go With Gabapentin For Phn
If you do have the lasting nerve pain of PHN, some doctors will prescribe anti-seizure medications, including Neurontin or Lyrica . Even though they were developed as anti-seizure medicines, they can help modulate the nerve pain until the nerves can heal, Dr. Auwaerter explains. These treatments can reduce pain signaling from the nerves to the brain by calming your neurotransmitters for a short time. They are FDA-approved as an effective treatment for PHN. Like antivirals, they require frequent daily dosing, usually three times per day.
Rebooting The Nervous System
Its like restarting a computer, Dr. Rosenquist says. When its running slowly or acting weird, you restart it. We are trying to turn that nerve off. When it comes back on, hopefully, it will send an appropriate transmission as opposed to a pain transmission.
Treatmentoptions for PHN patients include:
Patientswith refractory PHN rarely need opioid pain medication. However,you should be evaluated by a physician. We cant make a blanket statement abouttreatment. It is individualized, she says.
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Management Of Herpes Zoster And Postherpetic Neuralgia
SETH JOHN STANKUS, MAJ, MC, USA, MICHAEL DLUGOPOLSKI, MAJ, MC, USA, and DEBORAH PACKER, MAJ, MC, USA, Eisenhower Army Medical Center, Fort Gordon, Georgia
Am Fam Physician. 2000 Apr 15 61:2437-2444.
Patient information: See related handout on shingles, written by the authors of this article.
Herpes zoster results from reactivation of the varicella-zoster virus. Unlike varicella , herpes zoster is a sporadic disease with an estimated lifetime incidence of 10 to 20 percent. The incidence of herpes zoster increases sharply with advancing age, roughly doubling in each decade past the age of 50 years. Herpes zoster is uncommon in persons less than 15 years old. In a recent study,1 patients more than 55 years of age accounted for more than 30 percent of herpes zoster cases despite representing only 8 percent of the study population. In this same study, children less than 14 years old represented only 5 percent of herpes zoster cases.
The normal age-related decrease in cell-mediated immunity is thought to account for the increased incidence of varicella-zoster virus reactivation. Patients with disease states that affect cell-mediated immunity, such as human immunodeficiency virus infection and certain malignancies, are also at increased risk. Chronic corticosteroid use, chemotherapy and radiation therapy may increase the risk of developing herpes zoster.
How Is Shingles Diagnosed
Your healthcare provider will do a complete physical exam and ask about your medical history, specifically about whether you have ever had chickenpox.
Your healthcare provider will likely know right away that it is shingles based on the unique rash. The rash usually appears one area on one side of the body or face. It appears as red spots, small fluid- or pus-filled vesicles, or scabs.
The healthcare provider may also take skin scrapings for testing.
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What Is Nerve Pain
The term “neuropathic pain,” or nerve pain, refers to a wide range of problems that cause diseases of, or injury to, the nervous system. It is a category of pain syndromes and not a single problem.
Neuropathic pain can come from the malfunction of nerves or the brain associated with illness , infections , pinched nerves, nutritional deficiencies , injury , and medication/treatment side effects .
It is estimated that 50-80% of diabetics will develop some nerve injury with 30-40% of these having painful diabetic neuropathy unless preventive measures are taken such as nutritional support. Neuropathic pain affects approximately 0.6-1.5% of the U.S. population and 25-40% of cancer patients. This represents over 2 million Americans.
Neuropathies are characterized by pain that is burning, shooting , or stabbing. It also has an “electric” quality about it. Tingling or numbness and increased sensitivity with normal touch being painful are also commonly seen. Ongoing pain is often continually present regardless of what the patient does or does not do. In some cases, pain comes in sudden attacks without any apparent trigger. Diagnosis is made predominantly by history and physical examination, as testing often offers little benefit clinically unless the testing is looking for a treatable cause.
As with other pain problems, neuropathies are both expensive and poorly treated.
What Is The Best Way To Treat Pain Associated With Shingles
Dr. Anne Oaklander answers the question: ‘Best Way To Treat Shingles Pain?’
Best Way To Treat Shingles Pain?
— Question: What Is The Best Way To Treat Pain Associated With Shingles?
Answer: Shingles is generally a painful condition. It’s a rash that eats through the skin.
For some patients, they’ll be able to manage without pain medications, particularly if they have only a mild rash. But many patients will need medications for pain management. Some people may find over the counter anti-inflammatory and pain relief is adequate, such as acetaminophen, aspirin, or ibuprofen. But substantial numbers of people will need prescribed pain medications by their physician. This should be discussed with your physician because everyone’s situation is difficult.
Some patients, in fact, with severe pain may require admission to the hospital and treatment with intravenous or intraspinous pain medications.
Most people will be able to manage in their homes with prescriptions for medication that may include percocet or vicodin or other similar pain relievers as well as medications aimed at the nerves. These include gabapentin, as well as tricyclic medications such as nortriptyline, desipramine, or amitriptyline.
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Characteristics Of Shingles Pain
The varicella-zoster virus lies dormant in your nerve cells after you have chickenpox. If it reactivates, the virus travels through a nerve path in your body. Common descriptions of shingles symptoms include sensitivity to touch, itching, and nerve pain.
Cases of shingles often begin with a strange, tingling sensation in your skin. Then, oozing blisters develop. You can transmit the virus to people who havent had chickenpox at this stage if they come in contact with the blisters.
Once the blisters crust over, others cant get the virus. People who have had chickenpox cant catch the virus from others, because its already in their bodies.
The blistering patches characteristic of shingles usually appear on one side of your torso, wrapping around your waist. In rare cases, the rash may develop on one side of your face. Pain and blistering may last for several weeks.
Over-the-counter medications are generally ineffective for shingles. Depending on the severity of your condition, steroid or antidepressant medication can help manage symptoms until the blisters clear up.
Shingles And Your Eyes
If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.
Shingles painand other symptoms from an outbreak of herpes zosterusually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, its called postherpetic neuralgia .
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A Word About The Shingles Vaccine
If you are age 60 or over and have not had shingles, talk to your doctor about getting the shingles vaccine. Not only will it reduce your risk of developing shingles, but if you do develop shingles, youll be more likely to have a mild case. And, just as important, youll be much less likely to develop PHN if youve had the vaccine.
How Postherpetic Neuralgia Is Treated
Many effective treatments are used to treat PHN, including medications, physical therapy, exercise, and a range of alternative therapies. There is no one approach to treatment that will work for everyone. A combination of treatments often is needed to reduce pain.
Your doctor may first recommend drugs you can get at the drugstore without a prescription, such as acetaminophen , or non-steroidal anti-inflammatory drugs . Capsaicin creammade from hot chili pepper seedsis also something you may want to try. When applied to the affected skin it may help reduce PHN-related pain. All of these treatments may cause side effects, including the capsaicin cream, so it is important to talk to your doctor about the correct way of using them.
If these medications arent strong enough to treat your PHN symptoms, your doctor may suggest some of the following prescription medications:
- Tricyclic antidepressants: These include drugs such as amitriptyline , nortriptyline , and desipramine these drugs take a few weeks to start working.
- Anticonvulsants: These drugs include gabapentin , carbamazepine , and pregabalin .
- Antivirals: These drugs include valacyclovir and acyclovir.
- Lidocaine patches: Placed on your skin, the lidocaine in the patches penetrate your skin and go to the nerves sending the pain signals.
- Capsaicin patches : These prescription patches contain very high concentrations of capsaicin and is applied in the doctors office for one hour every three months.
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How Is Postherpetic Neuralgia Treated
Treatment for postherpetic neuralgia depends on the type and characteristics of pain experienced by the patient. Generally, there is not a single treatment of postherpetic neuralgia that relieves pain in all people. In many cases, it takes a combination of treatments to reduce the pain, and ensure patient comfort.
Possible pain management options include:
Non-drug treatments for postherpetic neuralgia include:
- Acupuncture. The Chinese art of pricking the skin or tissues with very fine needles.
- Moxibustion. A form of heat therapy in which dry plant materials called moxa are burned on or very near the surface of the skin. The intention is to warm and invigorate the flow of Qi in the body and dispel certain pathogenic influences.
- Relaxation techniques. These can include breathing exercises, visualization, and distraction.
- Heat/Cold Therapy. Depending on the patient, hot or cold packs may help reduce pain.
- Transcutaneous Electrical Nerve Stimulation. The stimulation of peripheral nerve endings by the delivery of electrical energy through the surface of the skin.
- Spinal cord stimulator. The electrical stimulation of the posterior spinal cord to block nerve impulses.
In some cases, pain treatment for postherpetic neuralgia brings complete relief. However, most sufferers still experience some pain, while some may not obtain any relief. Although some people must live with postherpetic neuralgia the rest of their lives, the condition often disappears on its own within five years.
Lasting Pain After Shingles
Pain that continues for a long time after a shingles rash has disappeared is called post-herpetic neuralgia. This is the most common complication of shingles. Its still not clear how it can be prevented or what the best treatment is.
Shingles typically causes a rash accompanied by pain in the affected area. The pain normally goes away when the rash goes away. This usually happens after two to four weeks. Pain that continues for longer is referred to as post-herpetic neuralgia. The word “post-herpetic” means “post-herpes” because the pain arises after infection by the herpes zoster virus. In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash has disappeared.
The main symptom of post-herpetic neuralgia is pain in the nerves . The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash yourself, turn over in bed, or hug someone. The pain and itching can be very severe and might keep you from sleeping.
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Have Shingles Get Treatment Take Action
If you have shingles, it’s important to talk to your doctor about your risk for developing PHN. Ask whether preventative treatment with antiviral drugs makes sense. If your doctor says it’s not necessary, ask why.
The full implications of the psychological risk factors for PHN aren’t clear yet, says Dworkin. But he suggests that people with shingles should try to stay active and connected.
“If psychological distress is a risk factor for PHN,” he says, “then we think that people who have shingles might benefit from getting out and not being isolated and homebound.”
You might make an effort to stay connected to family and friends and not to dwell on your symptoms. Also, keep in mind that even if you do develop PHN, there are treatments that can help.
“We have about a half dozen types of drugs that are used as first-line treatments for PHN,” says Dworkin. They include lidocaine patch , pregabalin , gabapentin , capsaicin , carbamazepine , tricyclic antidepressants, and painkillers.
The most important thing is to get prompt medical attention if you think you might have shingles.
“If you have a one-sided rash — especially if you’re over 50 — see your doctor right away,” says Dworkin. “It could be shingles. And we know that prompt treatment can dramatically reduce the likelihood of developing long-term pain.”
Coping With Shingles Pain
If you have shingles, you may be wondering how to cope with the pain:
- Be sure to get plenty of sleep and eat a healthy diet to help boost your immune system.
- Wear comfortable, loose clothing with natural fiber .
- Establish or maintain a regular exercise routine.
- Utilize home remedies to help soothe pain from blisters.
- Engage in activities that help take your mind off of the pain.
- Establish a routine to help manage stress.
- Seek out support when needed from family and friends as well as professional supportive services.
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What Are The Complications Of Shingles
Symptoms of shingles usually dont last longer than 3 to 5 weeks. However, complications can happen. The main complications that can result from shingles include:
- Postherpetic neuralgia . The most common complication of shingles is called postherpetic neuralgia . This continuous, chronic pain lasts even after the skin lesions have healed. The pain may be severe in the area where the blisters were present. The affected skin may be very sensitive to heat and cold. If you had severe pain during the active rash or have impaired senses, you are at increased risk for PHN. The elderly are also at greater risk. Early treatment of shingles may prevent PHN. Pain relievers and steroid treatment may be used to treat the pain and inflammation. Other treatments include antiviral drugs, antidepressants, anticonvulsants, and topical agents.
- Bacterial infection. A bacterial infection of the skin where the rash happens is another complication. Rarely, infections can lead to more problems, such as tissue death and scarring. When an infection happens near or on the eyes, a corneal infection can happen. This can lead to temporary or permanent blindness.