SHINGLES PAIN MANAGEMENT

When the virus that causes chickenpox reactivates, it causes shingles. Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. Anyone who’s had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie dormant for years. Eventually, it may reactivate and travel along nerve pathways to your skin producing shingles. The reason for the encore is unclear. But it may be due to lowered immunity to infections as you grow older.

Shingles is more common in older adults and in people who have weak immune systems. Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted infection.

Is it contagious?

A person with shingles can pass the varicella-zoster virus to anyone who isn’t immune to chickenpox. This usually occurs through direct contact with the open sores of the shingles rash. Once infected, the person will develop chickenpox, however, not shingles. Chickenpox can be dangerous for some groups of people. Until your shingles blisters scab over, you are contagious and should avoid physical contact with:

1. Anyone who has a weak immune system
2. Newborns
3. Pregnant women

Early symptoms of shingles include headache, sensitivity to light, and flu-like symptoms without a fever. You may then feel itching, tingling, or pain where a band, strip, or small area of rash may appear several days or weeks later. Arash can appear anywhere on the body but will be on only one side of the body, the left or right. The rash will first form blisters, then scab over, and finally clear up over a few weeks. This band of pain and rash is the clearest sign of shingles. The rash caused by shingles is more painful than itchy.

The nerve roots that supply sensation to your skin run in pathways on each side of your body. When the virus becomes reactivated, it travels up the nerve roots to the area of skin supplied by those specific nerve roots. This is why the rash can wrap around either the left or right side of your body, usually from the middle of your back toward your chest. It can also appear on your face around one eye. It is possible to have more than one area of rash on your body. Pain is usually the first symptom of shingles.

For some, it can be intense. Depending on the location of the pain, it can sometimes be mistaken for a symptom of problems affecting the heart, lungs or kidneys. Some people experience shingles pain without ever developing the rash. Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face.

When to see a Physician

Contact your health care provider promptly if you suspect shingles, but especially in the following situations:

1. The pain and rash occur near an eye. If left untreated, this infection can lead to permanent eye damage.
2. You’re 70 or older, because age significantly increases your risk of complications.
3. You or someone in your family has a weakened immune system due to some disease or chemotherapy
4. The rash is widespread and painful.

Shingles develops in stages:

Prodromal stage, before the rash appears

1. Pain, burning, tickling, tingling, and/or numbness occurs in the area around the affected nerves several days or weeks before a rash appears.
2. The discomfort usually occurs on the chest or back, but it may occur on the belly, head, face, neck, or one arm or leg.
3. Flu-like symptoms, usually without a fever, such as chills, stomachache, or diarrhea, may develop just before or along with the start of the rash.
4. Swelling and tenderness of the lymph nodes may occur.

Active stage where rash and blisters appear

1. A band, strip, or small area of rash appears. It can appear anywhere on the body but will be on only one side of the body, the left or right.Blisters will form. Fluid inside the blisters is clear at first but may become cloudy after 3 to 4 days. A few people won’t get a rash, or the rash will be mild.
2. A rash may occur on the forehead, cheek, nose, and around one eye, which may threaten your sight unless you get prompt treatment.
3. Pain, described as piercing needles in the skin, may occur along with the skin rash.
4. Blisters may break open, ooze, and crust over in about 5 days. The rash heals in about 2 to 4 weeks, although some scars may remain.

Postherpetic neuralgia with chronic pain stage

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Postherpetic neuralgia is the most common complication of shingles. It lasts for at least 30 days and may continue for months or years. Symptoms are:

1. Aching, burning, stabbing pain in the area of the earlier shingles rash.
2. Persistent pain that may linger for years.
3. Extreme sensitivity to touch.
4. The pain associated with PHN most commonly affects the forehead or chest. This pain may make it difficult for the person to eat, sleep, and do daily activities. It may also lead to depression.

Shingles may be confused with other conditions that cause similar symptoms. The rash from shingles may be mistaken for an infection from herpes simplex virus (HSV), poison oak or ivy, impetigo, or scabies. The pain from PHN may feel like appendicitis, a heart attack, ulcers, or migraine headaches.

Healing

Most people can expect the rash to heal within two to four weeks. Although some people may be left with minor scars, most will make a complete recovery with no visible scarring. In some cases, pain along the site of the rash can continue for several months or longer. This is known as post-herpetic neuralgia. You may have heard that once you get shingles, you can’t get it again. However, the CDC cautions that shingles can return multiple times in some people.