Shingles Pain

The pain of having shingles is only the beginning of the problem for many people. Often, a person develops a very painful neuralgia(nerve pain) that can last for years after the rash from shingles has disappeared. This chronic nerve pain is more common in people over 60.

Shingles is a skin eruption caused by the chicken pox virus which has infected a nerve. The chicken pox infection most likely occurred decades earlier, but the virus can remain dormant in the nerve cells until one’s immunity wanes, or some other stimulus causes it to travel down the nerve and break out as the skin eruption known as shingles.

Shingles begins as a burning and stinging pain in the skin. Two to four days later, the skin breaks out with red spots and blisters. The reaction on the skin resolves over two to three weeks, but the pain in the nerve may persist. The neuralgia is difficult to prevent and once it is established it is quite difficult to control.

Antiviral medications may help limit the development of neuritis, but they must be started early to gain the most benefit. The antiviral antibiotic should be started promptly if the skin starts to break out. The medicine can even be started before the rash erupts if a person develops the characteristic burning and stinging in the distribution of a nerve.

Nerve blocks done by injecting medication near the affected nerve may be effective and can be used at any time during an outbreak of shingles. These blocks are most effective early in the outbreak.

For the chronic neuritis, a prescription lotion containing capsaicin, the essential ingredient of hot chili peppers, may be helpful. This lotion gradually lessens the pain, but many people find it is too irritating to use. If this does not help, there are now a couple prescription medicines that can be used for nerve pain.

If all these treatments are ineffective and the pain is intolerable, surgery to cut the nerve is sometimes considered, although the nerve pain usually improves with time and patience is advisable.

As in most things prevention is the best approach. Vaccinations to prevent childhood chicken pox are available.

For adults who may have been exposed to the varicella (chicken pox virus) earlier in life there are vaccinations that greatly decrease the risk of shingles and shingles pain.