Posts Tagged ‘shingles’

Principles of PHN

May 22nd, 2018

Each year, about one million Americans are affected by shingles, that itchy, burning, blistery and usually very painful rash that can break out anywhere on your body. Shingles is caused by the herpes virus, varicella-zoster, the same bug that causes chickenpox.

So, if you’ve had chickenpox as a kid, that nasty virus can hang around inside your body, hiding in the nerves, and show up again later as shingles. This sneaky germ can lie dormant for decades before reactivating and causing shingles.

For many people who get shingles, the symptoms last from two to six weeks then go away, and you feel better. But an estimated one out of five people ends up with continuing pain after the shingles bout is over. The technical name for this pain complication is postherpetic neuralgia or PHN.

PHN is the result of the virus damaging the nerves of the tissues at the rash site. It’s thought to affect the proper functioning of the nerves that register sensations such as pain, pressure and touch. PHN pain can be rather mild, or it can be excruciating, prompted by the slightest stimulation, such as the touch of clothing or a breeze over the skin.

PHN pain can go away after one month or persist for months and even years after the shingles rash has gone away. No one knows why PHN goes away rather quickly in some people and lasts a long time in others.

There are several factors that increase your risk for getting PHN. They include older age, gender (the risk for longer-lasting PHN is higher in women) and having had shingles that affected the eyes. Having a family history of PHN also puts you at increased risk for developing the painful complication.

Most of the symptoms of PHN occur at the site of the original shingles rash. Some of the things to look out for include an occasional burning, shooting pain and a constant throbbing or aching pain. You may also feel extreme sensitivity to touch and/or temperature. Itching and numbness at the rash site also may occur.

If the nerves that control muscle movement are affected by the PHN, you could experience muscle weakness and even paralysis. Fortunately, this is rare.

Treatment for PHN is not the same for everybody. It is tailored to your specific symptoms and response to medications. There are several types of medications used to treat PHN pain. Your doctor may refer you to a pain management specialist to determine the right medication or combination of treatments that works best for you.

Some of the common medication treatments used for PHN include:

  • Lidocaine or capsaicin pain patches are applied directly to the skin.
  • Pain medications may include non-opioid and opioid drugs.
  • Antidepressants in lower doses than used to treat depression have been shown to help relieve pain.
  • Anticonvulsants traditionally used to treat seizures stabilize abnormal activity of the nerves.

Some people find transcutaneous electrical nerve stimulation, or TENS, beneficial for reducing the pain of PHN. Its effectiveness has not been proven through research, however.

Some experts believe that PHN can be prevented or its impact lessened if you’re treated with antiviral medication soon after your shingles is diagnosed. Others say the research doesn’t bear this out. Still, it’s often used as a therapy to shorten the course of the shingles outbreak and, hopefully, avoid PHN.

The best way to protect yourself against PHN is to get vaccinated against chickenpox, if you’ve never been, and especially against shingles. The shingles vaccine is not 100 percent effective, but it can greatly reduce the chance of getting the disease and its complications, including PHN.

It is recommended that everyone 50 and older, especially those over 60, get the shingles vaccine to help protect them against an outbreak of shingles and resulting PHN. It’s a little step. You can get the shot at most pharmacies, so it’s readily available.

It’s better to take a few minutes to get a quick shot in the arm than to risk spending months or years in horrible pain. It’s really an easy decision!

Seriously Shingles

November 14th, 2017

If you’re over 50, and especially if you’re 60 or older, you need to think seriously about shingles. In the US, there are an estimated one million cases of shingles each year, about 50 percent of them in people 60 or older. It affects one in three Americans during their lifetime. I don’t know about you, but I don’t like those odds. And from what I’ve heard, shingles is a real pain!

Shingles is a painful skin rash that usually appears in a strip on one side of the face or body. The pain has been described as excruciating, aching, burning, stabbing and shock-like. The rash eventually turns into clusters of blisters that fill with fluid then crust over. Shingles is caused by the varicella zoster virus, the same bug that causes chickenpox. Shingles is also called herpes zoster.

What happens is after you’ve had chickenpox, the virus stays in your body, but remains dormant in your nerves. In some people, a disease, stress or simply aging weakens the immune system (it’s not completely understood how), and that dormant virus reactivates, triggering a shingles outbreak. This is important to know because studies show more than 99 percent of Americans age 40 and older have had chickenpox, even if they don’t remember having it.

The active varicella zoster virus is contagious, but it doesn’t spread shingles to other people. The virus can cause chickenpox in those who’ve never had it or never been immunized against it. Since chickenpox vaccine has been a routine part of the childhood immunization schedule for years, this is a rare occurrence.

Symptoms of shingles often come in phases. It may start with a stabbing pain on one side of the body. You may experience a tingling, burning, stinging or itchy sensation followed in a few days by the outbreak of the rash. Other, associated symptoms can include headaches, fever, chills, nausea, malaise, swollen lymph nodes and body aches.

A shingles rash typically lasts from two to four weeks and is treated with antiviral and pain medications. However, one in five people with shingles will go on to experience severe pain long after the rash clears up. This condition is called post-herpetic neuralgia, and it can be debilitating. This pain can last for months or even years.

That’s why the Centers for Disease Control and Prevention (CDC) recommend people 60 and older be vaccinated against shingles. A single-dose vaccine, Zostavax®, has been in use in the United States since 2006. Now, people looking for protection from shingles have two choices. On October 20, the FDA approved a second vaccine called Shingrix. It is touted to offer stronger protection against the virus than Zostavax.

Studies showed Shingrix offered 98 percent protection against shingles in the first year, and that protection remained at 85 percent or higher three years after vaccination. By comparison, Zostavax offers 51 percent and 67 percent protection respectively. Shingrix also reduces the risk of post-herpetic neuralgia by 90 percent.

Two-dose Shingrix is expected to be available to consumers by the end of 2017.

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