Shingles Pain

The pain of shingles is, for many people, quite striking in its severity. Shingles, also known as herpes zoster, results from a reactivation of infection with the varicella zoster virus that causes chickenpox. Anyone who has had chickenpox may develop shingles later in life, although it is most common in older people. Shingles can appear many years after the initial chickenpox infection.

Shingles typically develops along the path of one nerve on one side of the body. Even though a blistering rash is characteristic of the condition, the pain can precede the rash. Often, the earliest signs and symptoms are a tingling or burning sensation on the skin. Especially if you have never had an outbreak of shingles, it can be very difficult to identify the pain as coming from an attack of shingles. Depending on the location of the involved nerve, the pain may be mistaken for

• a headache,
• appendicitis,
• heart attack,
• angina,
• sciatica,
• abdominal pain, or
• other conditions.

Many sufferers have described the pain as extremely severe, and some even require narcotic pain-relief medications.

A blistering rash usually accompanies the outbreak. New blisters continue to appear for several days, and the entire outbreak can take weeks to heal. Blisters may cover the entire path of the affected nerve, or the involvement may be patchy. Involvement of the eyes during a shingles outbreak can be particularly serious, since scarring of the cornea and permanent vision loss can result.

Another debilitating complication of shingles is known as postherpetic neuralgia. In postherpetic neuralgia, the pain of shingles persists even after the rash has healed. The diagnosis is made when pain lasts for over 30 days after an outbreak. This pain can last for weeks, months, or even years. Up to 15% of people with shingles have this persistent pain, and it is not understood why the pain persists in some people, but it is likely that some type of nerve damage or inflammation occurs during the outbreak that leads to continued pain.

Fortunately, a vaccine is available for older adults that can prevent shingles and reduce the incidence of postherpetic neuralgia. The Zostavax shingles vaccine was approved in 2006. In 2017, the U.S. Food and Drug Administration approved a newer vaccine, Shingrix, as the preferred vaccine. The older Zostavax is a live vaccine given as a single injection, and the newer Shingrix is a nonliving vaccine. The newer Shingrix vaccine is given in two doses two to six months apart. Shingles vaccination is recommended for use in people over 60 years of age.

Antiviral medications, including acyclovir (Zovirax) and valacyclovir (Valtrex), when administered early enough in the course of the disease, can decrease the severity and duration of the outbreak, reduce the risk of eye damage if the eyes are involved, and reduce the likelihood of developing postherpetic neuralgia. It is recommended that antiviral drugs be given within 72 hours of the onset of symptoms for the best outcome.

Pain medications can also be effective in controlling shingles pain. These may be applied to the skin, like the capsaicin topical patch (Qutenza) or lidocaine (cream, gel, patch, or spray). Oral medications that can help with pain control in people with shingles include tricyclic antidepressants such as amitriptyline and certain antiseizure medications such as gabapentin (Neurontin).