Shingles
Shingles is a viral infection that can cause a painful rash. The symptomatic rash of a shingles infection can occur almost anywhere on the body. However, it usually appears as a distinct band of blisters (dermatome) wrapped around the right- or left-hand side of the torso. The dermatome corresponds to a single sensory nerve in which the virus has been reactivated.
What Causes Shingles?
It is caused by the varicella-zoster virus, the same virus that causes chickenpox. Once the chickenpox has run its course, the virus enters the nerve tissues near your brain and spinal cord. The varicella-zoster virus remains here until it is “re-awakened”. Once reactivated, the virus travels along the nerves to the skin.
What are the Symptoms of Shingles?
General weakness and fever are amongst the first signs of a shingles infection. You may also experience a tingling sensation, burning, or pain in certain areas. After a few days, a rash will start to appear. The rash can turn into red, fluid-filled blisters.
Are Shingles Serious?
There are several options for treating the symptoms associated with shingles. However, there is no cure for shingles. If not treated promptly, shingles can lead to pain that does not go away even once the blisters have cleared up. This is known as postherpetic neuralgia (PHN). Shingles virus infections near your eye/s may cause blindness if not treated swiftly. Viruses affecting the motor neurons (nerves that control movement) may lead to temporary or permanent muscle weakness or paralysis.
Who Can Get Shingles?
Shingles most often occur in adults attending young children infected with the chickenpox virus. Older people are more vulnerable to this virus. As are those who have weakened immune systems.
Shingles Risk Factors
- Individuals over the age of 50.
- Patients with a disease that lowers their immunity. For example, cancer, HIV.
- People who are experiencing great stress or who have suffered a severe injury.
- Those who take medicines, such as corticosteroids, that weaken the immune system over the long-term.
How to Treat Shingles
There are many different options for the treatment of shingles symptoms. While these treatments will not cure the viral infection, they can shorten the duration of the infection and help to relieve the pain associated with shingles.
Antiviral Drugs
Prescription antivirals such as Acyclovir or Valacyclovir can dramatically reduce the risk of complications. To be efficacious, it is recommended that these drugs are administered in the first 72 hours of the rash forming.
Antihistamines
For patients with itchiness at the rash site, antihistamines such as topical Benadryl can help.
Calamine
Calamine lotion can also help to relieve the pain and discomfort of a shingles rash.
Capsaicin
A topical application of capsaicin (e.g. Zostrix) can help to relieve acute pain at the infection site. Prescription-only capsaicin patches (Qutenza) can be used in the treatment of nerve damage pain resulting from PHN.
Pain Medications
In a milder case of shingles, a doctor could prescribe over the counter (OTC) pain medications such as ibuprofen, naproxen, or acetaminophen. For severe pain associated with shingles, doctors might prescribe:
- Anticonvulsants. For example, gabapentin (Neurontin) and pregabalin (Lyrica).
- Local anesthetics, e.g. lidocaine (Lidoderm) applied topically in the form of a lotion or spray.
- Tricyclic antidepressants such as amitriptyline and desipramine (Norpramin) have shown efficacy in the treatment of nerve pain.
- Opioid based pain medications such as codeine, morphine can help treat cases of severe and chronic pain. However, one should take care to understand the many adverse side effects and the possibility of dependency with long term use.
- Ketamine infusion therapy can help in the treatment of chronic pain.
Intercostal Nerve Block to Treat Shingles Pain
With a shingles infection, it is often the intercostal nerves (nerves that run from the spinal cord to the sternum across the ribs) that become infected. An intercostal nerve block injection can greatly improve the blood circulation in the affected area as well as dramatically reduce pain. The advantage of nerve block treatments is that pain relief is for much longer periods (when compared to orally administered drugs). What is an intercostal nerve block? It is a treatment that combines the numbing effect of a local anesthetic and the anti-inflammatory action of a corticosteroid. How is an intercostal nerve block performed?
- Firstly, the patient receives intravenous medication to relax.
- The patient will then lie on the side that is not causing pain.
- An antiseptic is used to clean the area of skin where the injection needle will be inserted.
- A thin needle is then inserted between two ribs near the affected nerve and an anesthetic is injected. This will numb the area for a few hours.
- Using X-ray guidance, a second needle is inserted to inject a mixture of anesthetic, saline, and a corticosteroid into the area. The pain relief offered by the steroid takes two to three days to come into effect.
Risks and Negative Side Effects
Fortunately, with this treatment modality, risks are low. Bruising or soreness at the injection site could occur. Serious adverse effects are rare but include nerve damage, bleeding, collapsed lung, and infection.
The Shingles Vaccine
Prevention is better than cure! It is recommended that healthy adults over the age of 50 get the shingles vaccine, Shingrix. Shingrix can reduce your chances of getting shingles by up to 90 %. Common side effects are pain and swelling at the injection site, tiredness, headaches, diarrhea, chills, and fever.
For individuals 60 years and older, the older vaccine, Zostavax is recommended. It is not as efficacious as Shingrix. However, it is safer for older patients.
Patient-Specific Treatment is the Best Solution
The best treatment for shingles or postherpetic neuralgia is one that is customized to you as an individual. If you are experiencing the life-altering pain associated with this virus, do not hesitate to contact us today to find a Midsouth Pain Treatment Center branch near you. For your convenience, we have seven locations in Tennessee and Mississippi.
Schedule a consultation with one of our highly qualified medical professionals so that we can tailor a treatment plan to help you live a fuller, pain-free life.