Shingles Pain Management

Managing the pain of a shingles outbreak certainly has it's challenges. The pain can be excruciatingly painful and in some cases chronic, particularly when shingles pain lasts for over a month after the blisters have healed.

Herpes zoster (shingles) presents itself after years of latency in the nerve fibers of the body. Zoster is the result of a bout with chickenpox in childhood. Chickenpox is caused by the varicella zoster virus (VZV), which is the same virus that causes herpes zoster. The virus lives on in the nerves of the body long after having chickenpox, and becomes active again when the person has been under prolonged emotional stress and other conditions such as cancer treatments using chemo.

VSV travels along the nerve route, or dermatome, and works it's way up to the skin. The first clue to a shingles attack is the pain, followed by a red rash that turns into painful blisters filled with fluid. The blisters erupt spilling their contents of a clear fluid, that crusts over then healing takes place. The pain that is experienced during this time can last up to six months.

Pain Management:

Discomfort due to herpes zoster can be debilitating, requiring pain medication and antivirals to manage the symptoms. Antivirals need to be taken within 72 hours of onset of symptoms, but do not offer much benefit once the blisters have crusted over.

Corticosteroids for pain management include: Prednisone used in combination with acyclovir can reduce the pain of herpes zoster by lessening the nerve inflammation caused by active infection. It has also been shown to decrease residual nerve damage.

Analgesics: Pain can range from mild to severe and relief may be obtained from over-the-counter analgesics when pain is mild to moderate, while narcotics may be needed for more severe pain symptoms.

Lotions such as calamine are effective when applied to the seeping blisters to combat pain, and capsaicin cream when the blisters have crusted. Topical applications of lidocaine (Xylocaine) and nerve blocks have also been beneficial in easing the pain related to zoster outbreaks.

Eye involvement is treated with antiviral medications, as well as corticosteroids. When shingles appears on the face, the eyes can become infected, resulting in temporary or permanent vision loss. In these cases, consulting with an eye doctor is prudent.

Postherpetic Neuralgia is a painful condition that can occur after the blisters have healed. This pain is extreme nerve pain and can exist for up to six months and more. Medications that are helpful for this condition include topical skin applications, analgesics, antidepressants, and anticonvulsants.

Herpes zoster is common among the middle aged and senior populations, and is seen in children and young adults as well. If you've had chickenpox in the past, you are at an increased risk for developing shingles. However, if you have never had chickenpox and find yourself exposed to someone who has an active case of shingles, you are at risk for getting chickenpox, and consequently developing shingles later in life.

by Barb Hicks RN/LMT