Shingles

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is shingles?

Shingles (or herpes zoster) is a reawakening of the virus that once gave you chicken pox (varicella zoster). For most people, the virus lies dormant, often forever, in the nerves near the spinal cord. In 10% to 20% of adults, it mysteriously “wakes up,” causing a painful, blistery condition called shingles. Why this happens is anyone’s guess, but a weakened immune system seems to be key—from an illness, emotional stress, the use of immunosuppressant drugs, or even the natural aging process (many of those who get shingles are over age 60).

In about one-fifth of people with shingles, the discomfort persists for months after blisters disappear. Called post-herpetic neuralgia (PHN), this pain is the result of damage that the virus inflicted on your nerve cells. PHN discomfort can range from a continuous ache to severe shooting pain, leaving many people extremely sensitive to even a light touch. The good news is that most PHN sufferers eventually achieve near-complete pain relief.

Treatment for shingles

When it comes to the pain and itchiness of shingles, medications are the mainstay that bring relief: Antiviral drugs shorten the disease’s stay. Analgesics relieve pain, and topical lotions or creams soothe itchy skin. If you then develop PHN, your doctor will use a variety of treatments, beginning with painkillers. In severe cases, a spinal block may be needed to knock out the pain.

Medications for shingles

Your first step is to take an antiviral medication ASAP—within 72 hours of the rash’s appearance for best results. These recently developed drugs block the spread of the virus and can significantly reduce your chance for getting PHN. Their best selling point may be that they can dispatch shingles in seven to 10 days; untreated, shingles can take two to four weeks to run its course. Most commonly prescribed is an original antiviral, acyclovir (Zovirax), requiring five doses a day. You might ask about newer drugs—famciclovir (Famvir) and valacyclovir (Valtrex)—which require only three daily doses.

You’ll also need a pain reliever. If you have only mild discomfort, you may require only an OTC analgesic (aspirin, acetaminophen, ibuprofen). If you’re in more serious pain, your doctor will prescribe something more powerful, such as codeine, propoxyphene (Darvon), or hydrocodone (Vicodin). For the blisters, topical medications can relieve itching and keep infection at bay. Apply calamine lotion, or wipe the area with a towel moistened with zinc sulfate (0.025%) or Burrow’s solution (aluminum acetate). If your blisters become infected, see your doctor for an antibiotic.

The subsequent pain of PHN calls for stronger guns. One good option is a prescription topical anesthetic, such as the lidocaine patch (Lidoderm). Capsaicin cream (Zostrix), derived from the substance that makes chili peppers hot, has the same effect, but can take up to six weeks to be fully effective. Be sure to wait until your blisters have completely healed before using these creams.

Antidepressants or anticonvulsant drugs both have a solid history as effective pain therapies. Tricyclic antidepressants, taken in one-tenth the dose needed for depression, can block brain chemicals involved in pain perception. For PHN, nortriptyline (Pamelor, Aventyl) and amitriptyline (Elavil) are commonly used. Anticonvulsant drugs can help reduce pain by quieting overactive nerves. A relatively new drug in this class, gabapentin (Neurontin), has had good success in treating PHN. For severe pain, your doctor may prescribe opioids, such as oxycodone (OxyContin), alone or in combination with other drugs.

Lifestyle Changes

A number of simple strategies can help you get through a case of shingles. Try the following:

• Don’t scratch (no matter how much you want to). If you break the blisters, you risk infection. Keeping the blistered areas clean with soap and water will fight bacteria too.
• Cover your blisters to protect them. Loosely place gauze over the area during the day. While you sleep, gently wrap a wide elastic sports bandage around the gauze dressing to keep it in place.
• Apply cold, wet compresses or ice packs to itchy areas, or soak in a lukewarm bath laced with an Aveeno oatmeal product or cornstarch. Stay away from heat, which can intensify itchiness.
• Wear loose, breathable apparel. This will prevent clothes from rubbing against your irritated skin.

Related Procedures for Shingles

You might lower the volume on your shingles pain with transcutaneous electrical nerve stimulation (TENS). This technique delivers low-level electrical pulses to nerve endings via electrodes on your skin. This stimulates production of endorphins, your body’s natural painkillers. If your pain is so severe that it’s affecting the quality of your life, consult your doctor about an epidural block, injections of local anesthetics or steroids into the membranes surrounding your nerves. In a 2000 study, more than 90% of those given such injections reported good to excellent pain control. Injections of antiviral drugs plus steroids are another effective option for difficult cases of shingles.

Questions for Your Doctor

• My pain is a “10.” What can I realistically expect from pain medication?
• Might I have an undiagnosed illness that triggered my shingles?
• How likely is it that shingles will spread to other parts of my body?

Living with Shingles

If you’re living with shingles, here are a few quick tips to help you take control:

• Insist on real pain relief. Although temporary, the pain of shingles can sometimes be intense. If your doctor implies you should “learn to live with it,” find another doctor. A pain specialist may be your best bet.
• De-stress to decrease PHN pain. Studies show you’ll calm down and reduce your pain by practicing meditation, deep breathing, or progressive muscle relaxation. Visit a skilled practitioner of hypnosis, biofeedback, or acupuncture. They can help you achieve similar results.
• Stay away from people who haven’t had chicken pox. Shingles is not contagious, but you can give chicken pox to children and adults who have never had the varicella virus or the chicken pox vaccine.

Prevention of shingles

• Eat well. Diets that are low in vitamins, minerals, and antioxidants can weaken your immune system, making you more vulnerable to infection. Strive for a low-fat diet rich in fruits, vegetables, and whole grains.
• Address your stress. Stress can trigger shingles, and exercise can help reduce stress. Try walking briskly for half an hour a day or take up swimming, biking, or yoga.
• Avoid chicken pox. The best way to avoid shingles is to avoid chicken pox. A chicken pox vaccine (Varivax) is now available. If you’ve never had chicken pox and take the vaccine now, it might protect you from getting shingles, too, although doctors aren’t yet certain if the vaccine works against both conditions.
• Take B12. For pain relief from PHN, ask your doctor about vitamin B12 injections, which can strengthen the tissue that covers your nerves.
• Rub it in. Applying a cream containing capsaicin (the heat in hot peppers) three or four times a day has reduced pain for many sufferers after a couple of weeks of use.
• Rub it on. Gels containing glycyrrhizin, an active component of licorice, have been proven to block the shingles virus when rubbed into the affected areas three or four times a day.
• Sleep now. Bed rest is recommended during the early stages of shingles, especially if you have a fever. Because open blisters can spread chicken pox to anyone who hasn’t had it before, change bed linens frequently.
• Soothe your skin. To promote healing (and relaxation), add a few drops of rose, lavender, bergamot, or tea tree oil to your warm bath. Mix them in a carrier oil, such as vegetable oil, first.
• Numb the pain. Calendula lotion or ointment applied to blisters several times a day eases pain. Or apply a paste made of two crushed aspirin tablets and two tablespoons rubbing alcohol three times a day to soothe throbbing nerve endings.
• Itching for relief. Ask your pharmacist to prepare a mixture with 75 percent calamine, 20 percent rubbing alcohol, and 1 percent each phenol and menthol. (Inert ingredients account for the remaining 2 percent.) Apply to blisters continuously until you’re healed. Other itching remedies include vitamin E oil or aloe vera gel.
• Ice, ice, baby. Apply ice packs for 10 minutes at a time to affected areas. Keep them off for at least five minutes between applications.
• Pack it on. Compresses containing aluminum acetate solution, available over the counter in pharmacies, can help relieve the itching from shingles.
• Dust your skin. To keep your clothes from rubbing against your blisters, dust yourself with colloidal oatmeal powder.
• Pins and needles. There are reports that acupuncture is an effective treatment for shingles. It is especially helpful for easing the pain of PHN.
• Stress busters. Try tai chi, meditation, and self- hypnosis techniques to help reduce your stress and manage pain. Even after your symptoms disappear, these techniques can help you cope with the day-to-day stress that can lead to shingles.