Shingles (Post Herpetic Neuralgia)
WHAT IS SHINGLES?
Shingles, or herpes zoster, is a virus that causes nerve roots near the spinal cord to become inflamed. This inflammation causes painful blisters on the skin, typically in a band on the chest and abdomen. They may also occur around the eyes, or on the face, arms, thighs or neck.
The term herpes zoster (“creeping belt” in Greek), describes the belt-like formation of skin blisters. The term shingles is derived from the Latin for belt or girdle.
WHAT CAUSES SHINGLES?
A virus causes shingles – the same one that causes chicken pox in children. After a childhood outbreak of chicken pox, the virus may remain sleeping in nerve roots near the spine. Later, if resistance to infection is weakened by stress, lack of sleep, illness or injury, the virus may be reactivated to cause shingles. Sometimes, shingles appears for no apparent reason.
TREATMENT FOR SHINGLES:
WHAT ARE THE WARNING SIGNS OF SHINGLES?
At first, the virus multiplies in nerve roots near the spine, injuring or killing cells. It then travels down sensory nerves to the skin’s surface, erupting in a rash of blisters that looks like chicken pox. The resulting pain, itching, or tingling may occur before or after the rash appears.
WHO IS AT RISK?
Since resistance to disease is often weakened with age, people over age 65 are more likely to suffer from shingles. It is estimated that more than half of all people over the age of 80 will experience shingles.
IS SHINGLES CONTAGIOUS?
Yes and no.
You cannot “catch” shingles since the only way to become infected is after having chicken pox.
You can, however, pass the virus along to others during the blister phase. Adult friends are at risk if they have not previously had chicken pox. Children are particularly at risk. Nearly 15% of children have caught their chicken pox from this type of exposure.
HOW IS SHINGLES TREATED?
Medical opinion varies widely. Some physicians prefer to let shingles cure itself, others prescribe ointments, prescription drugs, compresses, or special injections called nerve blocks. Your physician can recommend the treatment that is best for you.
WHAT IS A NERVE BLOCK?
The body’s impulses are controlled by a vast network of nerves called the nervous system. This complex framework connects to the brain via the spinal cord. The autonomic nervous system, a branch of the main nervous system, controls involuntary body mechanisms such as blood pressure, breathing, heart rate, circulation and feelings of pain. The autonomic nervous system includes the sympathetic and parasympathetic branches.
A nerve block designed to fight shingles is an anesthetic injection near the sympathetic nerves. Numbing the nerve prevents pain signals from reaching the brain. The exact mechanism of how these nerve blocks provide prolonged relief is not fully understood.
WHAT HAPPENS DURING A NERVE BLOCK PROCEDURE?
The procedure, performed on an outpatient basis, is relatively simple. First, your physician administers a mild anesthetic to numb the injection site. Then the nerve block itself is given. The entire procedure typically takes less than 5 minutes; however, you will be at the outpatient surgical facility about 2 hours for your initial consultation, the procedure, and observation. One to 3 nerve blocks over the course of several weeks may be required to treat shingles.
CAN EARLY TREATMENT HELP?
Yes. Medical evidence suggests that nerve blocks administered in the early stage of a shingles outbreak help speed healing, sometimes within 24 to 48 hours. The risk of post-herpetic neuralgia is significantly reduced as well.
WHAT IS POST-VIRAL OR POST-HERPETIC NEURALGIA?
The initial outbreak of blisters from the shingles virus often takes from 6 months to 1 year to heal. Afterwards, most patients have no further pain. For some, however, the pain continues. This condition is called post-viral or post-herpetic neuralgia, which means “nerve pain after the virus.”
IF THE BLISTERS ARE GONE, WHY DO I STILL HAVE PAIN?
The exact cause of post-herpetic neuralgia is not known. Many physicians and researchers believe the shingles virus – although injured during initial medical treatment – may still be living in certain nerve roots near the spine.
HOW CAN I GET RELIEF FROM POST-HERPETIC NEURALGIA?
Since the pain’s source is in nerve roots deep beneath the skin, the same prescription drugs used to fight the shingles virus itself may help. Avoiding nuts, peanut butter, chocolate, gelatin and table salt may offer relief as well. All contain certain chemicals that the shingles virus needs to thrive. Ointments applied to the skin typically offer little benefit.
For most, surgery or nerve blocks (like those described above) are required. Such procedures help to permanently block offending nerves from sending pain signals to the brain. Regardless of how your original outbreak of shingles was treated, you may benefit from nerve blocks; however, a series of many nerve blocks may be required once post-herpetic neuralgia develops.
AFTER TREATMENT, WILL SHINGLES OR POST-HERPETIC NEURALGIA COME BACK?
It is possible, but following the full course of treatment advised by your physician will help to reduce that risk.
DOES POST-HERPETIC NEURALGIA HAVE SIDE EFFECTS?
Living with the constant pain of post-herpetic neuralgia can cause mental and behavioral changes. Some patients report fatigue, loss of appetite, loss of sleep, feelings of isolation and even severe depression. Your physician can help treat these conditions.
HOW CAN I HELP OTHERS REDUCE THEIR RISK?
Tell your friends to eat properly and get plenty of sleep because a weakened immune system in those who have had chicken pox can trigger an outbreak of shingles. More importantly, tell them about the warning signs of shingles. If tell-tale blisters appear, encourage them to seek early treatment to help reduce the risk of postherpetic neuralgia.
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Jasmine Lamb, M.D.
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