In years past, all children went through the ritual of contracting the childhood disease chickenpox. In more recent generations, better preventive treatments have been discovered. We can prevent chickenpox with the varicella vaccine, shingles with the Zostavax vaccine, and now we can reduce the risk of developing PHN with nerve blocks & antiviral medications. Many shingles patients receive good treatment from their provider, but most are not given the best treatment, which includes referral to a pain specialist for nerve blocks. But there is more to consider about the causative agent, the varicella-zoster virus.
Varicella-zoster is highly contagious and manifests itself in childhood as chickenpox, a rash covering the entire body in blister-like, crusted lesions. After recovery from the chickenpox, the virus retreats to a dormant state, residing quietly for years in the nerve root. Shingles is a reactivation of that virus, causing a painful blister-like rash limited to one side of the body along the affected nerve root. Shingles is more commonly experienced by elderly, debilitated, sick individuals with weak immune systems. Complications of shingles range from scarring to the development of a lifelong, excruciatingly painful condition called post-herpetic neuralgia (PHN).
Post-herpetic neuralgia is characterized by severe, unrelenting, lifelong pain in the now-healed shingles rash site. Unfortunately, up to 34 percent of shingles patients may develop this complication. The cause of PHN is unknown. However, many pain specialists and the literature review support the need for early antiviral therapy and nerve blocks to reduce not only the duration and intensity of the pain, but also to reduce the risk for developing PHN.
In past generations, the treatment of shingles and PHN was limited to comfort measures such as ice packs, capsaicin cream and high risk, possibly habit-forming pain pills. Today, improved medications are aimed not only at reduction of disease severity, intensity and duration, but also at prevention of PHN. Some of the new drugs commonly prescribed today include: 1.) antivirals such as acyclovir to reduce severity and duration of the shingles outbreak, 2.) seizure medications, like gapapentin to reduce neuropathic pain, 3.) topical analgesics, like lidoderm patches and sometimes strong opioids to reduce severe pain.
The importance of early interventional nerve blocks administered by an experienced pain specialist cannot be over-emphasized as this treatment yields immediate relief of acute shingles pain and reduces risks for lifelong PHN pain. If your healthcare provider fails to refer you to a pain specialist for a nerve block of the affected nerve root; you will be denied a crucial chance for not only immediate pain relief, but more importantly, an opportunity to reduce the risk of developing this incurable neuralgia.