Perhaps you thought that you were off the hook when your chickenpox cleared up way back when. But the very same virus can come back-with a vengeance--as shingles. Today, antiviral drugs and good home care can ease the pain and discomfort.
Shingles (or herpes zoster) is a reawakening of the virus that once gave you chickenpox (varicella zoster). For most people, the virus lies dormant, often forever, in the nerves near the spinal cord. Mysteriously, in 10 to 20 percent of adults, it literally 'wakes up', causing a painful, blistery condition called shingles (see illustration below for its progession). Why this happens is anyone's guess, but a weakened immune system seems to be key--from an illness, emotional stress, use of immunosuppressant drugs or even the natural ageing process (many of these who get shingles are over age 60).
In about one-fifth of people with shingles, the discomfort doesn't disappear when the blisters do but persists for months. 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, even to a light touch. The good news is that most PHN sufferers eventually achieve nearly complete pain relief.
LIKELY FIRST STEPS
When it comes to the pain and itchiness of shingles, medications are the mainstay that bring relief: antiviral drugs to shorten the disease's stay, analgesics for pain and topical lotions or creams to soothe itchy skin. If you when
After the chickenpox disappears, the varicella virus lies dormant in nerves near the spine. Once reawakened, it nerves near the spine. Once reawakened, it migrates along a nerve fibre to the surface of the skin where it causes a burning or tingling sensation (1). Two to five days later a red rash that produces itchy, fluid-filled blisters appears (2), usually in a swath on one side of your body. The band-like pattern matches the distribution of the particular nerve affected by the virus. Over the next week or so, the blisters fill with pus, may break open (3) and finally crust over (4). After the rash disappears, the virus-damaged nerves can cause an extremely painful condition called post-herpetic neuralgia (5), which can last for months.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Antiviral drugs Taken early, reduce severity of condition.
------------------------------------------------------------------------------------------------------------------------------------------
Pain relievers Prescription drugs for serious pain.
-------------------------------------------------------------------------------------------------------------------------------------------
Topical medications To relieve bothersome itching.
------------------------------------------------------------------------------------------------------------------------------------------- Specialised painkillers For acute and chronic (PHN) pain.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
No scratching To prevent infection.
----------------------------------------------------------------------------------------------------------------------------------------------
Cold soaks To soothe itchy blisters.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
TENS Electrical stimulation to ease nerve pain.
---------------------------------------------------------------------------------------------------------------------------------------------
Epidural block Injections into nerve membranes.
develop PHN, your doctor will use a wide variety of treatments, beginning with painkillers; in severe cases, a spinal block procedure may be needed to knock out the pain.
TAKING CONTROL
We know that the chickenpox vaccine is very effective at protecting against the chickenpox disease, preventing almost 90% of cases.
Recent evidence now suggests that this vaccination may provide protection against shingles, especially in those people with poor immune systems. It also seems that it might be beneficial for adults to have a booster dose of the vaccine.
Medications
Your first step is to take an antiviral medication ASAP-within 72 hours of the rash's apperance 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 7 to 10 days; untreated, shingles can take two to four weeks to run their course. Most commonly prescribed is an original antiviral, acyclovir (Zovirax), requiring five does 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're one of the lucky ones, with only mild discomfort, you may require only an analgesic (aspirin, paracetamol, ibuprofen). If you're in more serious pain, you will need something more powerful, such as Panadeine or the prescription-only Panadeine Forte. For the blisters, topical medications can relieve ithcing and keep infection at bay. Pat on calamine lotion or wipe the area with a towel moistened with zinc sulphate (0.025 percent) or Burrow's solution (aluminum acetate). If your blisters do become infected, see your doctor for an antibiotic.
The subsequent pain of PHN calls for stronger guns. One good option is a prescription topical anaesthetic, such as teh lignocaine 5 percent ointment or patch. Capsaicin cream (Zostrix), derived from the substance that makes chillies hot, has the same effect but it can take up to six weeks to be fully effective. Be sure to wait until your blisters have completely healed to use these creams.
Antiderpressants 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
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THE EYES HAVE IT: OPTHALMIC SHINGLES
Sometimes the shingles virus can infect the nerves of the eyes, creating a potentially serious condition called opthalmic shingles. If blisters appear on your nose or forehead or if your eyes hurt, call an opthalmologist right away.
Along with eye pain, opthalmic shingles can produce blurred vision and a sensitivity to light. The acutely painful phase can least several weeks. More seriously, it can lead to comeal scratching or scarring, inflammation of the iris and surrounding blood vessels and impaired vision. In severe cases, opthalmic shingles may cause blindness.
Treatment for opthalmic shingles focuses on oral antiviral medication and pain relievers. You may also be given antiviral or antibiotic eyedrops.
Despite the serious complications opthalmic shingles can cause, chances are that you will get through an outbreak with no serious problems. As with all types of shingles, the sooner you get treatment, the better off you'll be. If you start on an antiviral medication right away, ophthalmic shingles should clear up in a few weeks with no lasting effects.
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your perception of pain. For PHN, nortriptyline (Allegron) and amitriptyline (Endep, Tryptanol) 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 (Endone), either alone or in combination with other drugs.
PROMISING DEVELOPMENTS
There are a number of simple strategies that you can employ to help you get through a case of shingles. Try the following:
You might lower the volume on your pain with transcutaneous electrical nerve stimulation (TENS). This technique delivers low-level electrical pulses to nerve endings via electrodes on your skin, thereby stimulating 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 anaesthetics or steroids into the membranes surrounding your nerves. In a 2000 study, more than 90 percent of those given such injections reported good to excellent pain control. Injections of antiviral drugs plus steroids are another option for difficult cases.
What is happening
Shingles (or herpes zoster) is a reawakening of the virus that once gave you chickenpox (varicella zoster). For most people, the virus lies dormant, often forever, in the nerves near the spinal cord. Mysteriously, in 10 to 20 percent of adults, it literally 'wakes up', causing a painful, blistery condition called shingles (see illustration below for its progession). Why this happens is anyone's guess, but a weakened immune system seems to be key--from an illness, emotional stress, use of immunosuppressant drugs or even the natural ageing process (many of these who get shingles are over age 60).
In about one-fifth of people with shingles, the discomfort doesn't disappear when the blisters do but persists for months. 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, even to a light touch. The good news is that most PHN sufferers eventually achieve nearly complete pain relief.
- Antiviral medication within 48 to 72 hours to shorten the virus's duration and prevent complications.
- Pain relievers to reduce shingles discomfort.
- Topical lotions to calm the itchy rash.
- Specialised drugs for pain if PHN develops.
QUESTIONS TO ASK
- My pain is a '10'. What can I realistically expect from pain medication?
- Is it possible that I have an undiagonsed illness that triggered my shingles?
- How likely is it that shingles will spread to other parts of my body?
Treatments
When it comes to the pain and itchiness of shingles, medications are the mainstay that bring relief: antiviral drugs to shorten the disease's stay, analgesics for pain and topical lotions or creams to soothe itchy skin. If you when
After the chickenpox disappears, the varicella virus lies dormant in nerves near the spine. Once reawakened, it nerves near the spine. Once reawakened, it migrates along a nerve fibre to the surface of the skin where it causes a burning or tingling sensation (1). Two to five days later a red rash that produces itchy, fluid-filled blisters appears (2), usually in a swath on one side of your body. The band-like pattern matches the distribution of the particular nerve affected by the virus. Over the next week or so, the blisters fill with pus, may break open (3) and finally crust over (4). After the rash disappears, the virus-damaged nerves can cause an extremely painful condition called post-herpetic neuralgia (5), which can last for months.
Treatment Options
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Antiviral drugs Taken early, reduce severity of condition.
------------------------------------------------------------------------------------------------------------------------------------------
Pain relievers Prescription drugs for serious pain.
-------------------------------------------------------------------------------------------------------------------------------------------
Topical medications To relieve bothersome itching.
------------------------------------------------------------------------------------------------------------------------------------------- Specialised painkillers For acute and chronic (PHN) pain.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
No scratching To prevent infection.
----------------------------------------------------------------------------------------------------------------------------------------------
Cold soaks To soothe itchy blisters.
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
TENS Electrical stimulation to ease nerve pain.
---------------------------------------------------------------------------------------------------------------------------------------------
Epidural block Injections into nerve membranes.
develop PHN, your doctor will use a wide variety of treatments, beginning with painkillers; in severe cases, a spinal block procedure may be needed to knock out the pain.
TAKING 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.
- De-stress to decrease PHN pain. Studies how you'll calm down and reduce your pain simultaneously by practising medication , deep breathing or progressive muscle relaxation. Or visit a skilled practitioner of hypnosis biofeedback or acupuncture; they can help you achieve similar results.
- Stay away from people who haven't had chickenpox. Your shingles are not contagious, but you can give chickenpox to children and adults who have never had the varicella virus or the chickenpox vaccine.
We know that the chickenpox vaccine is very effective at protecting against the chickenpox disease, preventing almost 90% of cases.
Recent evidence now suggests that this vaccination may provide protection against shingles, especially in those people with poor immune systems. It also seems that it might be beneficial for adults to have a booster dose of the vaccine.
Medications
Your first step is to take an antiviral medication ASAP-within 72 hours of the rash's apperance 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 7 to 10 days; untreated, shingles can take two to four weeks to run their course. Most commonly prescribed is an original antiviral, acyclovir (Zovirax), requiring five does 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're one of the lucky ones, with only mild discomfort, you may require only an analgesic (aspirin, paracetamol, ibuprofen). If you're in more serious pain, you will need something more powerful, such as Panadeine or the prescription-only Panadeine Forte. For the blisters, topical medications can relieve ithcing and keep infection at bay. Pat on calamine lotion or wipe the area with a towel moistened with zinc sulphate (0.025 percent) or Burrow's solution (aluminum acetate). If your blisters do become infected, see your doctor for an antibiotic.
The subsequent pain of PHN calls for stronger guns. One good option is a prescription topical anaesthetic, such as teh lignocaine 5 percent ointment or patch. Capsaicin cream (Zostrix), derived from the substance that makes chillies hot, has the same effect but it can take up to six weeks to be fully effective. Be sure to wait until your blisters have completely healed to use these creams.
Antiderpressants 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
---------------------------------------------------------------------------------------------------------------------------------------
THE EYES HAVE IT: OPTHALMIC SHINGLES
Sometimes the shingles virus can infect the nerves of the eyes, creating a potentially serious condition called opthalmic shingles. If blisters appear on your nose or forehead or if your eyes hurt, call an opthalmologist right away.
Along with eye pain, opthalmic shingles can produce blurred vision and a sensitivity to light. The acutely painful phase can least several weeks. More seriously, it can lead to comeal scratching or scarring, inflammation of the iris and surrounding blood vessels and impaired vision. In severe cases, opthalmic shingles may cause blindness.
Treatment for opthalmic shingles focuses on oral antiviral medication and pain relievers. You may also be given antiviral or antibiotic eyedrops.
Despite the serious complications opthalmic shingles can cause, chances are that you will get through an outbreak with no serious problems. As with all types of shingles, the sooner you get treatment, the better off you'll be. If you start on an antiviral medication right away, ophthalmic shingles should clear up in a few weeks with no lasting effects.
----------------------------------------------------------------------------------------------------------------------------------------
your perception of pain. For PHN, nortriptyline (Allegron) and amitriptyline (Endep, Tryptanol) 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 (Endone), either alone or in combination with other drugs.
- The Shingles Prevention Study is a large, five-year trial sponsored by the US National Institutes of Health, testing whether a vaccine will prevent shingles in people ages 60 and older who have had chickenpox.
There are a number of simple strategies that you can employ to 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 run the risk of 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 guaze dressing to keep it in place.
- Apply cold, wet compresses or ice packs to itchy areas or soaks in a lukewarm bath laced with bi-carbonate of soda or Pinetarsol to relieve the itch. (Heat intensifies the itchiness so avoid it.)
- Wear loose, breathable apparel. This will keep your clothes from rubbing against your irritated skin.
You might lower the volume on your pain with transcutaneous electrical nerve stimulation (TENS). This technique delivers low-level electrical pulses to nerve endings via electrodes on your skin, thereby stimulating 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 anaesthetics or steroids into the membranes surrounding your nerves. In a 2000 study, more than 90 percent of those given such injections reported good to excellent pain control. Injections of antiviral drugs plus steroids are another option for difficult cases.
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