If you have ever had chicken pox – and 95% of Americans have – you are at risk for the blistering rash and severe pain of shingles.
People who get shingles are often tempted to wait for the problem to clear up on its own, but waiting is the worst thing you can do. Without prompt treatment with antiviral medication, shingles pain may become chronic.
What is Shingles?
Shingles is a disease of skin and nerves caused by reactivation of the varicella zoster virus (VZV) – the same virus that causes chicken pox. After a bout of chicken pox, the virus doesn’t leave the body. It travels up sensory nerve fibers from the skin and establishes dormant infections in sensory ganglia that last for the rest of an individual’s life.
No one knows what causes reactivation, but it is clear that shingles occurs most frequently in people with reduced immunity – for example, people taking corticosteroids or immunosuppressant drugs, undergoing chemotherapy or suffering from HIV infection. In some cases, shingles may even be triggered by psychological stress. Shingles is especially common among people over 50, presumably because immunity declines with age. Among people who live to 85, half will get the disease.
You can’t get shingles unless you’ve had chicken pox, and you can’t catch shingles from someone who has shingles. However, if you’ve never had chicken pox, you can catch chicken pox from a shingles sufferer. The shingles virus is similar to herpes simplex virus, which causes genital herpes. Unlike herpes simplex virus, however, VZV is not transmitted through sexual contact.
Shingles usually begins with pain on one side of the body – typically on the trunk or around the eye. The usually intense pain is caused by inflammation that’s created as the virus reproduces within nerve tissue. Pain is generally followed by a rash in the same area one to three days later. Until the telltale rash appears, shingles is notoriously hard to diagnose. Depending on where the pain is, shingles can resemble a heart attack, gall bladder attack, appendicitis, kidney stone or a ruptured spinal disk. Shingles can even be mistaken for glaucoma, if the eye is affected.
Once your doctor has ruled out these ailments, keep a close watch for the rash. It’s essential to begin treatment as soon as the rash appears. If treatment isn’t started quickly, the virus may spread to other nerve cells, which can cause muscle weakness, hearing loss or other complications – such as the chronic pain condition, post-herpetic neuralgia (PHN), in which just the pressure of clothing against the skin can be unbearable.
Until a few years ago, there was no treatment for shingles. Then it was found that the antiviral drug acyclovir (Zovirax) was effective. Acyclovir must be taken in very high oral doses, or injected. Some doctors used to prescribe steroids along with acyclovir, in the hopes that by reducing inflammation PHN would be prevented.
Studies have shown that steroids do not prevent PHN, and they can lead to stomach ulcers and raise blood pressure. Two new antivirals, famciclovir (Famvir) and valacyclovir (Valtrex) are more easily absorbed than acyclovir and more effective. Aspirin, ibuprofen or acetaminophen may be enough in some cases to dull the pain. For severe pain, doctors may prescribe codeine or another narcotic.
If the pain becomes chronic, you should consult a doctor who specializes in pain management. Tricyclic antidepressants – prescribed at lower doses than for depression – are effective in 60% to 70% of patients with PHN. Some patients appear to get relief from alternative treatments such as acupuncture or electrical stimulation.