Shingles, a viral infection of the nerve roots, affects 500,000 people in the U.S each year. Most people recover from their bout, but for as many as 20%-30% of them, the pain doesn’t go away. It can last for months, years, or even the rest of their lives.
These people have what’s called postherpetic neuralgia (PHN), the result when the shingles virus damages the nerves of the skin. In some cases, the pain is mild. In others, even the slightest touch — from clothing or even a breeze — can be excruciating.
PHN causes a great deal of suffering and high social costs. It can severely disrupt people’s lives. But the good news is that there are drugs that can help treat and even prevent PHN, and doctors are learning more about who is at greatest risk of developing this debilitating condition.
What Is Shingles and Postherpetic Neuralgia?
Shingles is caused by the varicella-zoster virus, the virus that also causes chickenpox. In a person who has been exposed to chickenpox — or its vaccine — the virus never really goes away. It can lie dormant in the body’s nerves.
In most cases, it stays that way. But in some — especially people with immune systems weakened by disease or treatment — the virus can reappear. This is likely to happen years or decades after the person had chickenpox.
When it comes back, the virus can cause shingles: a rash that often appears as a band on one side of the body. Early shingles symptoms can include:
- Light sensitivity
- Flu-like symptoms without fever
- Itching, tingling, or extreme pain where the rash is developing may come next, and the pain can be moderate to severe. Are you contagious? Though people who haven’t had chickenpox can catch that condition from you, the shingles itself isn’t contagious.
For reasons that experts don’t really understand, the pain of shingles lingers for some. If the pain lasts for at least four months after the shingles rash appeared, a person is diagnosed with PHN. In some people, the pain will subside. In others, it won’t.
Risk Factors for Nerve Pain After Shingles
Researchers have long known that older people are more likely to get PHN, the nerve pain after shingles, but recent studies have found other factors that increase risks.
In one study published in the journal Neurology, researchers looked at data from 965 people with shingles. The researchers identified five risk factors for developing PHN in people who had been recently diagnosed with shingles:
- Presence of symptoms before the rash appeared, like numbness, tingling, itching, or pain
- Severe pain during the illness’ initial stages
- Severe rash
Importantly, the researchers found the more risk factors you have, the greater the risk of developing PHN.
For instance, 17% of women with shingles went on to get PHN. 26% of people with severe pain did, too. But 50% of women who were over 60 and had symptoms before the rash, severe rash, and acute pain went on to get PHN.
The Emotional Toll of Nerve Pain After Shingles
Researchers are not just looking at biological and neurological risk factors for this nerve pain after shingles. Recently a study looking at psychological risk factors revealed that psychological stress can be a potent risk factor for PHN.
The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.
Preventing Nerve Pain After Shingles
But if you’re worried about PHN, don’t despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: Famvir, Valtrex, and Zovirax. These medications need to be started within two to three days of the onset of shingles. Others argue that preventative treatment should only be given to those at greater risk.
Have Shingles? Get Treatment, Take Action
If you have shingles, it’s important to talk to your doctor about your risk for developing PHN. Ask whether preventative treatment with antiviral drugs makes sense. If your doctor says it’s not necessary, ask why.
The full implications of the psychological risk factors for PHN aren’t clear yet, but people with shingles should try to stay active and connected. You might make an effort to stay connected to family and friends and not to dwell on your symptoms. Also, keep in mind that even if you do develop PHN, there are treatments that can help.
The most important thing is to get prompt medical attention if you think you might have shingles. If you have a one-sided rash — especially if you’re over 50 — see your doctor right away; It could be shingles. And we know that prompt treatment can dramatically reduce the likelihood of developing long-term pain.
Non-Surgical Orthopaedics, P.C. treats acute and chronic pain, including pain associated with Shingles. Call 770-421-1420 for more information or to schedule an appointment.