Shingles: The real meaning of pain

With advancing age, staying on top of medical concerns can be a challenge. There are prostate exams, mammograms, cancer screenings, diabetes checks and plenty more. But shingles, an illness that is difficult to prevent and whose cases are on the rise, tends to fall under the radar for those older than 50.

Even with a vaccine in place, shingles affects one in five Americans, and one in three who live to the age of 80. A blistering skin rash that brings discomfort and pain characterizes the condition medically known as herpes zoster.

For those who have endured chickenpox as children, sadly, shingles could mean a second, more painful, round of it many years later. Simply described, shingles is the varicella-zoster virus that has remained dormant in the body’s nerve cells for years. In some people, the varicella virus reactivates, while in others it doesn’t.

Unlike polio or common cold viruses, somehow, the varicella-zoster virus is able to hide or “adapt” in a nerve cell region just outside the spinal column known as the sensory ganglion area, explained Dr. Alan Greenberg, director of the Infectious Diseases Division at University Medical Center.

“I liken it to a hibernating bear,” he said. “We don’t really know why yet, but there’s something in that tissue that allows the virus to set up a home there. … Then it can be stress or any of these other triggers that could reactivate it in some people.”

EARLY SIGNS INCLUDE SKIN RASH, PAIN

While a rash is the most common symptom of shingles, there are ways to detect the virus prior to its presentation on the body, said Dr. Lisa Rosenberg, assistant professor of medicine at Touro University Nevada College of Osteopathic Medicine. The professor, who also comes across shingles cases in her private practice, describes a “constant stabbing or burning pain” on one side of the body prior to the rash that could trigger a trip to the doctor or urgent care.

Usually, the pain occurs about two to three days prior to the rash, and if one can start antiviral medicine at this time prior to the rash surfacing, it can greatly reduce the length of illness and the potential for pain after cure. It usually takes about three to four weeks to recover from shingles.

“I’d say the public awareness of shingles is pretty good. Once you’ve developed the rash, people know (to go to the doctor). It’s getting seen before, that’s difficult (for people to understand),” she said.

Rosenberg said the pain will occur on one side of the body because the virus becomes active on the left or the right of the spinal cord, then seeks out more nerves that trigger a pain response in the brain.

ANTIVIRAL DRUGS CAN TREAT CONDITION

Doctors often put shingles patients on antiviral medicines such as Zovirax, Famvir or Valtrex. These drugs are designed to help keep the virus from multiplying in hopes of shortening the duration of the illness and rash. Many sufferers also opt for traditional pain medicine, such as Tylenol or Advil. But, unfortunately, Greenberg noted, getting through shingles also means waiting for the virus to run its course.

Even more importantly, Greenberg said, is avoiding the impacts of PHN, or post-herpetic neuralgia, which happens in about 15 percent of the patients, he estimates. PHN can mean more stabbing pain for several months after the rash is gone.

“I’d say PHN is one of the big things that people don’t often hear about,” Greenberg said.

The doctor also recommends keeping rashes and lesions clean with a warm compress. He noted if antiviral drugs are given within 72 hours of the rash appearing, then there is a greater chance for a quicker healing process and lower possibility of PHN afterward.

Shingles is contagious to people who have not had chickenpox during the time that its new blisters are forming. Once blisters are crusted over, usually after about two weeks, they are not contagious anymore. Rosenberg says picking at blisters could also cause secondary bacterial infections.

SHINGLES MAY BE SIGN OF BIGGER PROBLEM

Researchers have found that a compromised immune system is what enables varicella zoster to flare up in some people. Greenberg and Rosenberg said immune system suppressing drugs such as those taken by rheumatoid arthritis patients or those with other rheumatic conditions are one possible culprit for shingles. The role of stress and its ability to suppress the immune system could also be a factor, Greenberg said. Also, cancer patients who have undergone chemotherapy are immune-compromised and could find themselves battling shingles. Greenberg also said, in some cases, shingles could be a sign of a bigger disease the body is battling.

“The general rule is that when someone presents with shingles, they should have a gender- and age-specific general medical evaluation after it (shingles) is resolved. There may be undetected breast or colon cancer causing the immune suppression. If you’ve presented at 60 and haven’t had a colonoscopy, get it,” he added.

VACCINE CAN HELP PREVENT OUTBREAKS

After Food and Drug Administration approval about seven years ago, Zostavax from Merck & Co. has become a go-to vaccine for those 60 and older wanting to avoid a shingles outbreak. Studies published in 2006 indicate a roughly 50 percent reduced risk of shingles, according to the Centers for Disease Control and Prevention.

The vaccine uses a small dose of varicella zoster to promote an immune response from the body in hopes of keeping shingles at bay. The vaccine has seen positive results in those older than 60 and was recently approved by the FDA for those 50 and older as well.

The Advisory Committee on Immunization Practices has not recommended the vaccine for those age 50 to 59, not because of a lack of efficacy, but instead because of supply concerns, Greenberg said. Rosenberg said she would even recommend the vaccine, which can cost between $150 and $200, to those as young as 40.

Despite some supply concerns, the vaccine is widely available in Nevada. The Southern Nevada Health District offers Zostavax, but people also can find it by checking with local pharmacies and physicians, said health district spokeswoman Stephanie Bethel. For more information about the vaccine, visit www.cdc.gov/vaccines.

While there are no specific lifestyle recommendations available for shingles prevention, Greenberg said he offers some general diet and lifestyle tips to patients to keep the stress down and the immune system healthy.

“Basically it’s all those things Grandma told you. Get enough sleep. Eat foods you can recognize and don’t have a million ingredients in them. If you have physical or emotional stress, find an outlet like exercise, meditation or yoga,” he said.

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