Health NW: Coping with the pain of shingles

<center>Kathryn B. Brown, FNP</center>

Shingles is the common name for a disease called herpes zoster. The pain of shingles can be intense, because it's a deep pain that originates in the nerves beneath the skin.

Anyone who develops shingles must have had chickenpox in the past. The varicella-zoster virus that causes the two infections is the same. Sometimes, after a bout of chickenpox, the virus remains dormant in nerve cells in the body. Years later, the virus can reactivate and cause shingles.

People over the age of 50 and those with immune-system problems are most likely to develop shingles, but it can happen at any age and does not necessarily mean that the immune system is not functioning well.

Usually, the first symptom of shingles is itchiness or a deep, tingling pain under the skin on just one side of the body. A few days later, a cluster of red bumps will appear on one side of the body or the face, often in a belt-like pattern. These bumps turn into painful blisters. After a week or two, the blisters dry up, turn into scabs, which will fall off as the infection resolves.

Along with the painful rash, people with shingles might also develop flu-like symptoms: fever, body aches, headaches and fatigue.

This may not sound very serious, but the pain of shingles can be severe and it can continue for months after the rash disappears. About 20 percent of people with shingles have "post-herpetic neuralgia," which means they have continuing nerve pain after the rash of shingles is gone.

The treatment for shingles has three aims: to reduce symptoms by suppressing the varicella-zoster virus, to reduce pain and to reduce the chances of scarring.

The virus can be suppressed by anti-viral medicines (acyclovir, famciclovir or valacyclovir), but these are effective only if started within a few days of start of symptoms. Starting an anti-viral medicine early in the course of the infection reduces the likelihood of post-herpetic neuralgia. Steroids such as prednisone may also decrease the chance of this problem.

To reduce pain, some people need only an over-the-counter pain medicine (acetaminophen or ibuprofen). For more intense pain, prescription-strength pain medicines containing codeine or other narcotics may be needed. Also, steroid pills are often helpful in reducing pain.

Scars are often left after a bout of shingles, especially in severe cases. Scratching the shingles rash or picking at the scabs can make scarring worse. Applying compresses with an astringent solution (Burow's or Domeboro solution) can help dry up oozing blisters. Lotions containing calamine can reduce pain and itching, and can be used on open sores. Once the sores have healed, capsaicin cream can be used to reduce pain and itching.

People with shingles can shed the varicella-zoster virus and are contagious until their rash dries up. Anyone who has not had chickenpox or the chickenpox (varicella) vaccine could get chickenpox if exposed to the lesions of a person with shingles.

The most common location for shingles is the torso, but in some cases, the face and eyes can be involved. In this case, the treatment is the same but an eye specialist (ophthalmologist) should be consulted.

For the ongoing pain of post-herpetic neuralgia, several types of medicines can be helpful. Besides pain medicines, topical capsaicin cream or lidocaine patches may help. Certain types of antidepressants and antiseizure medicines are used to help reduce the sensation of nerve pain. Nerve blocks and transcutaneous electric nerve stimulation (TENS) are also used with some success.

Kathryn B. Brown is a family nurse practitioner with a master's degree in nursing from OHSU. Is there a health topic you would like to read about? Send your idea to

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