Pain from shingles can be tough to treat

Posted on Thu, Aug. 02, 2007

Q: I'm 74 years old and have suffered from shingles for three months. The last two months I've had the after-effect of the illness, post-herpetic neuralgia. My family doctor prescribed the antiviral drug Famvir. At the end of 30 days, my drug plan no longer paid for it and I've been taking acyclovir instead. There are scars and dark splotches on the skin that are very red and still painful at times. Can you advise?

A: Shingles is caused by the same virus as chickenpox. After you've had chickenpox, the virus lies dormant in nerve pathways. Decades later it can reawaken grumpily as shingles.

Pain, fever, malaise or headache may occur two to three days prior to the eruption of the typical shingles red rash with fluid-filled blisters. The rash follows nerve pathways along one side of the trunk of the body. Less commonly, the ear or the face, neck and area around the eye are affected.

The rash, characterized by pain, burning, tingling, itching and skin numbness or hypersensitivity, generally lasts seven to 10 days, though the skin may not heal for several weeks.

When lesions are active, the virus can be transmitted to others, causing chickenpox in those who have never had chickenpox or the chickenpox vaccination.

The post-herpetic neuralgia you mention is nerve pain that persists after the acute rash runs its course. The pain can be debilitating and is often described as sharp, burning, stabbing or aching. Numbness, tingling and extreme sensitivity to touch and temperature changes also are common.

The condition occurs in about 10 to 15 percent of those who get shingles. In your age group, the percentage is much higher.

An antiviral drug such as Famvir, Valtrex or acyclovir early on - within 24 to 72 hours of the onset of shingles - may help prevent post-herpetic neuralgia or curb the severity of pain associated with it. Antiviral drugs are unlikely to help after lesions have crusted.

Corticosteroids such as prednisone also may be helpful during the early phase.

The pain of post-herpetic neuralgia is a type of neuropathic pain that can be challenging to treat.

Prescribed oral agents include tricyclic antidepressants such as amitriptyline, anticonvulsants such as gabapentin (Neurontin) and pregabalin (Lyrica), and pain relievers such as NSAIDs (e.g., ibuprofen) and opioids (narcotics). Capsaicin (cream, lotion, gel) and the lidocaine patch are pain relievers applied directly to the skin.

You appear to be well into the after-phase of shingles. An antiviral drug does not seem warranted at this time, so I'm puzzled that you're still on acyclovir. I'd recommend that you check to make sure this is your doctor's intention.

Q: I've just gotten over shingles. Should I get the new shingles vaccination to prevent another attack down the road?

A: No need. Having had shingles appears to "self-immunize" you against future outbreaks.

The new shingles vaccine is called Zostavax. It's approved for adults age 60 and older to prevent shingles (and associated post-herpetic neuralgia).

Richard Harkness is a consultant pharmacist, natural medicines specialist, and author of eight published books. Write him at 1224 King Henry Drive, Ocean Springs, MS 39564; or rharkn@aol.com.

Posted 8-15-07