Shingles Pain No Laughing Matter
Shingles is part of a triple whammy of illnesses -- including chickenpox and postherpetic neuralgia -- caused by the same virus lingering in your body.
By Gina Shaw
Reviewed By Brunilda Nazario
The sneaky little varicella-zoster virus can remain dormant in the nerve of a person who has had chickenpox and re-emerge years later. Occasionally it will probe your body's defenses, and if your resistance happens to be lower -- more likely as you get older, for example, or if you've recently had an illness that's played havoc with your immune system -- the virus shoots down a nerve, causing the numbness, itching, severe pain, and later the blistering rash associated with shingles.
But the rash isn't the worst part, says Karl R. Beutner, MD, PhD, associate clinical professor of dermatology at the University of California, San Francisco, who calls the disease "highly underrated." Before the rash appears on your body, the inflammation in the affected nerve causes a tingling, "creepy-crawly" pain called postherpetic neuralgia that can linger for months and even years. "There have been quality-of-life studies showing that a bad case of shingles is worse than a heart attack in terms of how long the pain lasts," Beutner says.
"Shingles patients suffer from a lot of pain, sometimes even needing narcotic pain relievers," says Joseph Jorizzo, MD, professor and former founding chairman of the department of dermatology at Wake Forest University School of Medicine and vice president of the American Academy of Dermatology.
Don't believe it? A bad case of shingles was the only thing, other than his heart bypass surgery, to cause talk-show host David Letterman to miss work in over 20 years, and it kept him out just as long as the bypass did. He described the experience vividly in an "all shingles, all the time" top 10 list the night of his return: "The BLEEP suckers are so BLEEPING painful, every minute you pray some giant son-of-a-BLEEP will shove a red-hot poker up your BLEEP."
Complications Can Linger
Letterman's case of shingles was particularly troublesome because it involved his eyes, which can be potentially devastating to a patient's vision, Jorizzo says. "If you get involvement with this virus on your cornea, it can actually produce a permanent, vision-affecting scar on the cornea."
But the most common complication of shingles is postherpetic neuralgia -- persistent nerve pain that lasts long after the skin lesions heal. "The incidence of postherpetic neuralgia rises dramatically in people over 50," says Jorizzo. "It's probably due to some sort of scar produced by the inflammation caused by all the viral particles coming down the sensory nerve."
It's important to get shingles treated early and aggressively, both to minimize pain in the acute phase and prevent chronic pain. "If you use approved oral antiviral agents like acyclovir in high doses -- as much as five times the dose you use for a fever blister -- for seven days during the acute phase, you can significantly reduce the duration of postherpetic neuralgia," Jorizzo says. Don't put off a trip to the doctor for that painful, itchy rash, either: Studies indicate that it's important to start antiviral therapy within 48 to 72 hours of the onset of any shingles symptoms.
Early intervention with antiviral drugs can also prevent long-term eye damage from shingles, according to a study published in the March issue of the Archives of Ophthalmology. Mayo Clinic scientists tracked 323 cases of eye shingles in Minnesota between 1976 and 1998; almost 9% of the patients who went without antiviral therapy suffered serious eye conditions within five years of getting eye shingles, while only 2% of those who got antiviral drugs had the complications.
Treat Early, Treat Hard
Many patients often don't get in soon enough for antiviral therapy to help much, says Beutner. "On the first day they have a little back pain, and then on the second day they notice a little rash and think maybe it's a spider bite. On day three, they notice more pain and the rash gets worse, so they call the doctor and maybe get in on day six or day seven," he says. "For people who end up with chronic pain, it can be a really bad cycle, especially if you're older and have other health problems."
So what are the early signs that you might have shingles? "If you have pain, and then a rash, that's an important signal," says Beutner. "There are very few other rashes that are actually painful." The rash usually forms a band-like pattern on one side of the body, following along the affected nerve.
Also, many people with shingles get what's called allodynia, a heightened sensitivity to touch. If the rash is on your chest, for example, just having your clothes touch the skin can be painful. (Letterman joked that he was thrilled to be able to button his shirt again.)
If you notice signs like these, don't delay. "If you have a painful, blistering rash, that means you need to get in to the doctor sooner rather than later," says Beutner.
Can you get shingles more than once? The jury's still out on that one, but most experts say no. "It seems that almost without exception, people get it either not at all or once in their life," Jorizzo says. "If they keep getting it again and again in the same area, it's likely to be herpes simplex -- the fever blister virus, not varicella-zoster."
And while you can't catch shingles from someone who has shingles, a person who's never had chickenpox before can get them for the first time by being exposed to shingles.
Published May 12, 2003.
SOURCES: Joseph Jorizzo, MD, professor of dermatology, Wake Forest University School of Medicine. Karl Beutner, MD, PhD, associate clinical professor of dermatology, University of California, San Francisco. Archives of Ophthalmology, March 2003.
Last Editorial Review: 1/31/2005 6:09:41 AM
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