Mays & Schnapp Pain Clinic and Rehabilitation Center

Dreadful. Horrific. Agonizing.

Ask anyone who has ever experienced shingles and, if you don’t hear one of those words, you’ll hear something like “it was the worst pain I’ve ever experienced”. This year, nearly one million new cases will be diagnosed, primarily affecting people age fifty or older. One out of five people will get shingles in their lifetime.

The virus that causes the infection, Herpes Zoster, is the same one that causes chickenpox. In fact, only people who have had chickenpox can develop shingles. Some of the viruses remain “asleep” in areas of the nervous system. The immune system prevents the infection from coming back for years, but as a person ages, the virus may re-awaken as a nerve and skin infection.

The areas commonly affected are the chest, abdomen and the face. Pain may precede the skin eruption for several days and many people misinterpret the pain as a heart attack or gallbladder problem. Water-filled blisters appear, along with a rash that follows the path of the nerve, radiating, for example, from the spine to the abdomen, rarely crossing the midline.

The attack may persist for days or weeks, but may be reduced in intensity if anti- viral medications, such as Acyclovir or Famvir, are promptly used. During the attack the pain follows the path of the nerve and is usually described as burning and shock-like. Strong analgesics may be required, sleep is difficult and exhaustion is common.

As severe as shingles pain is, it is usually gone within a few weeks, especially with younger people. Older folks have an increased likelihood of developing post herpetic neuralgia (PHN), a persisting pain, even after the virus disappears. At least one out of ten people who develop shingles will have some pain one year later. The damaged nerve and the spinal cord attached to it become a “pain generator” due to misfiring and hypersensitivity of the nerve cells.

Treatment Options

PHN can be very difficult to treat. Only a few drugs have been found effective, such as amitriptyline, an antidepressant which is also useful in treating certain types of pain.

Neurontin and Lyrica, drugs for the treatment of seizures, are also approved for use in PHN. Analgesics and sleeping pills are often added for comfort. Treatments with anesthetic ointments or patches (Lidoderm) can be helpful. Nerve blocks of local anesthetics and cortisone can also be very helpful.

Instead of guessing which patients will develop PHN, a current concept in the prevention of PHN relies on “pre-emptive analgesia”, treating shingles from the early stages to keep the neuralgia from developing. Instead of saving blocks and anti-neuralgic medications, early use may decrease the chances of PHN.

A relatively new modified chickenpox vaccine for adults, called Zostavax, confers additional immunity. Zostavax represents the current best solution to preventing this severe affliction. Ask your family doctor if you might benefit from this new measure.

By Moacir Schnapp, M.D. - Mays and Schnapp Pain Clinic and Rehabilitation Center, a joint venture between Baptist Memorial Health Care and Kit Mays, M.D., and Moacir Schnapp, M.D., is the only comprehensive center for the treatment of severe chronic pain in the Mid-South