What to do If You have Shingles

Shingles, a painful nerve disorder, doesn’t just happen to older people. But when older people do develop shingles, they’re more likely to suffer from the aftermath of the disease, called postherpetic neuralgia, or PHN.

Shingles occurs when the chickenpox virus, which can lie dormant in your body for decades, becomes reactivated. The first symptom is a blistery rash that breaks out along the pathway of the affected nerves. Shingles gets its name from the Latin word that means belt—singulum, because the rash usually appears near the waist. In many cases, shingles goes away after one or two difficult weeks.

Symptoms of PHN
But in some cases, the shingles outbreak damages the nerves in such a way that their ability to transmit signals from the skin to the brain is affected. The result can be pain that lasts for quite a long time. The pain is usually at the place where the rash appeared. There’s usually a burning or aching sensation. It also may become numb. Itching is also common—an itch so strong that people injure themselves by scratching so hard and so frequently. For some people, their skin is so sensitive that clothing against it causes excruciating pain. Even a gentle breeze can cause pain.

About half the people with PHN develop clinical depression, because they begin to understand that the pain may not go away.

Quick, aggressive treatment can help many people
If you think there’s a chance that you may be coming down with shingles, you should see your doctor right away. Antiretroviral drugs, such as acyclovir, can help to reduce the severity of the shingles attack itself and reduce by half the chances that you’ll develop PHN.

For people who do develop PHN, there are treatments that you can try:

• Creams made of capsaicin, found in the seeds of chili peppers (although for some people, this makes things worse)
• Over-the-counter creams containing aspirin or lidocaine
• Skin patches with prescription-strength lidocaine or xylocaine
• Prescription drugs such as anti-depressants, anti-convulsants or pain killers such as morphine

Treatment regimens can be complicated though, especially because older people may already be taking medications for other condition, and they may experience drug interactions. They also may be more likely to experience side effects from powerful pain killers.

A recent review of 35 clinical trials has found that the older and less expensive medicines used to treat PHN may be as effective as the newer, more expensive ones. Drugs that were seen as effective included the older tricyclic antidepressants such as amitriptyline, nortriptyline and desipramine and opioids, including oxycodone.

Drugs that were not effective for shingles, according to the study review, included dextromethorphan, ibuprofen and codeine.

The newer, more expensive drugs such as Neurontin and Lyrica worked well, but researchers recommend that people try these only if the others have failed.

The lidocaine patch also worked well, and may be an especially attractive option for patients because it avoids many of the side effects that accompany drugs taken by mouth.

Vaccine effective for 2 out of 3
The new shingles vaccine is expected to protect two out of three people who get it. But that does leave one third of the people unprotected. Which gets back to the fact that you should think of shingles as a medical emergency, and see your doctor about it immediately.

Those in the medical community aren’t sure whether children who have received the chickenpox vaccine will be protected from shingles later in life. The vaccine is made from a form of the virus that’s weaker than an actual case of chickenpox. It may be less likely to cause shingles.

Source:
The New York Times, Health and Fitness Section, “For Some Patients, Shingles Is Just the Beginning,” 7 June 2005; PLOS Medicine, July 2005