Treatment For Herpes Zoster Pain

What Causes Herpes Zoster

After primaryinfectionvaricellaVZV remains dormant in dorsal root ganglianerve cells in the spine for years before it is reactivated and migrates down sensory nerves to the skin to cause herpes zoster.

It is not clear why herpes zoster affects a particular nerve fibre. Triggering factors are sometimes recognised, such as:

• Pressure on the nerve roots
• Radiotherapy at the level of the affected nerve root
• Contact with someone with varicella or herpes zoster

Who Gets Herpes Zoster

Anyone who has had varicella may subsequently develop herpes zoster. Zoster can occur in childhood but is much more common in adults, especially older people. People with various kinds of cancer have a 40% increased risk of developing zoster. People who have had zoster rarely get it again the chance of getting a second episode is about 1%.

Herpes zoster often affects people with weak immunity.

What Are The Symptoms Of Shingles

Early symptoms of shingles may include:

Other signs and symptoms that appear a few days after the early symptoms include:

• An itching, tingling or burning feeling in an area of your skin.
• Redness on your skin in the affected area.
• Raised rash in a small area of your skin.
• Fluid-filled blisters that break open then scab over.
• Mild to severe pain in the area of skin affected.

Read Also: Lysine Vitamins For Genital Herpes

A Multimodal Approach To Therapy May Help Relieve The Chronic Pain That Some Individuals Experience Months After Initial Shingles Infection

After a bout of shingles, many people recover well and leave the pain of the condition behind. But not all. And for those who dont, life can get and stay miserable.

Postherpetic neuralgia, or PHN, is the most common long-term complication of varicella-zoster virus reactivation. VZV is the culprit behind varicella, or chickenpox. Reactivation is called herpes zoster or shingles.

One month after the onset of shingles , up to 14% of people develop this pain. That percent drops to 5% at the 3-month mark, when it is then viewed as chronic pain.¹

Anyone can develop PHN, but it is more likely to occur in immunocompromised and older individuals. It may add to the overall health miseries of older patients, who are more likely than younger patients to be coping already with other conditions.¹

I probably see a case once a week to once a month, said Narayan R. Kissoon, MD, assistant professor of neurology and anesthesiology at Mayo Clinic, Rochester, MN. The pain persists and never goes away. Some can have a mild attack. But it can be pretty debilitating and have a major impact on their lives. A lot depends, he said, on which nerves are affected.

What Is Postherpetic Neuralgia

Postherpetic neuralgia is a complication of shingles infection . Shingles is caused by the reactivation of the varicella-zoster virus, which is the same virus that causes chickenpox.

Shingles causes a painful, blistering rash and other symptoms. The rash most commonly occurs in a band pattern on one side of your body, usually on your trunk . The rash turns into blisters. As the rash/blisters go away, pain may remain. When pain remains, the condition is called postherpetic neuralgia.

Recommended Reading: Laser Hair Removal And Herpes

What Are Risk Factors For Shingles

A weakened immune system might wake up the virus. After youâve had chickenpox, youâre more likely to get shingles if you:

• Are 50 or older
• Are under a lot of stress
• Have cancer, HIV, or another disease that lowers your bodyâs defenses
• Have had a serious physical injury
• Take long-term steroids or other medicines that can weaken your immune system

But many people who get shingles donât fit into any of these categories.

Can You Get Shingles If You Havent Had Chickenpox

No. You cant get shingles if youve never had chickenpox, but you can get chickenpox from someone who has shingles. If youve never had chickenpox and you come into direct contact with the oozing, blister-like rash of someone with shingles, the varicella-zoster virus can infect you and you would develop chickenpox.

Once youve had chickenpox, you could develop shingles at some point in your life. This is because the varicella-zoster virus never fully goes away after youve had chickenpox. It lies quietly inactive in your nerve tissue. Later in life, the virus may become active again and appears as shingles.

Can you get chickenpox more than once?

Its rare to get chickenpox twice in your life. Once youve had chickenpox, youre usually immune to it for the rest of your life. However, its not totally impossible. If you have a severely weakened immune system , you can get chickenpox a second time. If youve had chickenpox, you are more likely to get shingles at some point in your life than a repeat bout of chickenpox.

Don’t Miss: How To Treat Oral Herpes Fast

Help Is Available For Phn

Fortunately,early treatment for shingles can lower your chances of getting PHN.

For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.

Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.

However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.

Treatment Of Acute Herpes Zoster

A meta-analysis of five randomized controlled trials considered the time to complete resolution of acute herpes zoster pain.1 When treatment was initiated within 48 hours, complete resolution of pain occurred sooner than with placebo . This also was true when treatment was initiated between 48 and 72 hours .

A single RCT2 compared valacyclovir with acyclovir . This study found that the mean times to complete resolution of pain were 44 days for valacyclovir and 51 days for acyclovir when treated within 48 hours .2 When treatment was initiated between 48 and 72 hours after the onset of symptoms, the mean times to complete resolution of pain were 36 days for valacyclovir and 48 days for acyclovir .

Another RCT3 compared two dosage regimens of famciclovir with placebo in 419 adults treated within 72 hours of symptom onset. Famciclovir slightly accelerated the rate of lesion healing compared with placebo .

In a single RCT4 with 55 patients, famciclovir was shown to have equal effectiveness to acyclovir . This small and possibly underpowered study found that there was no significant difference regarding the median time to full lesion crusting, the rate of full crusting at day 28, the median time to resolution of acute pain, or the rate of acute pain at 28 days.

Don’t Miss: Does L Lysine Help With Genital Herpes

Can You Get Shingles More Than Once

Although possible, its rare to experience shingles more than once. In a 2019 study , researchers found the reoccurrence rate of shingles was 5.3 percent over an average of a 4.4-year follow-up period.

The researchers found that experiencing shingles that lasted more than 30 days significantly increased the risk of reoccurrence. Other risk factors were:

• being 51 to 70 years old
• having shingles lasting longer than 90 days
• having a blood cancer, an autoimmune disease, high blood pressure, or dyslipidemia

Shingles And Your Eyes

If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.

Shingles painand other symptoms from an outbreak of herpes zosterusually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, its called postherpetic neuralgia .

Don’t Miss: How To Get Rid Of Herpes On Vagina

Can You Still Develop Shingles If Youve Been Vaccinated For Chickenpox

Yes. Despite being vaccinated for chickenpox, you can still get shingles. No vaccine is 100% protective, and the effectiveness of vaccines lessens with time. However, people who get the chickenpox vaccine are significantly less likely to develop shingles later in life compared with people who never received the chickenpox vaccine. One recent 12-year study found that the number of shingles cases was 72% lower in children who had received the chickenpox vaccine compared with those who didnt.

Treatment Of Herpes Zoster

The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.

You May Like: How To Clean Herpes Outbreak

Who Should Be Vaccinated With Shingrix

The Shingrix vaccine is recommended for those 50 years of age and older who are in good health.

You should get the Shingrix vaccine even if:

• Youve had shingles already.
• Youve been previously vaccinated with Zostavax . If youve been vaccinated with Zostavax, wait at least eight weeks before getting vaccinated with Shingrix.
• You dont know for sure if youve ever had chickenpox.

Ask your healthcare provider, who knows your entire health history if getting this vaccine is right for you.

Management Of Postherpetic Neuralgia

Theoretical models suggest that reducing pain during the acute phase of herpes zoster may stop the initiation of the mechanisms that cause chronic pain, thus reducing the risk of postherpetic neuralgia.4 If the condition develops, treatment focuses on preventing a chronic pain syndrome. Several medications have proved effective for postherpetic neuralgia and should be selected based on individual patient characteristics.7,19â22 Many of these medications require dosing adjustment in older patients and in those with reduced creatinine clearance.

Tricyclic antidepressants, such as amitriptyline, desipramine , and nortriptyline, have pain-modulating effects in neuropathic and other chronic pain states. They are the mainstay of treatment for postherpetic neuralgia, and evidence supports their effectiveness.20 In older patients, tricyclic antidepressants should be started at lower doses given at bedtime, and the patient should be monitored for adverse effects, including interactions with other medications.

Studies involving anticonvulsants showed that gabapentin and pregabalin reduce pain from postherpetic neuralgia by approximately 50 percent.7,19,20 Another study comparing the maximum tolerated dosages of gabapentin and nortriptyline found that both reduced pain scores, but gabapentin was associated with fewer adverse effects.7

Read Also: How Quickly Does Herpes Show Up

When To Seek Medical Advice

Shingles is not usually serious, but you should see your GP as soon as possible if you recognise the symptoms. Early treatment may help reduce the severity of your symptoms and the risk of developing complications.

You should also see your GP if you are pregnant or have a weakened immune system and you think you have been exposed to someone with chickenpox or shingles and haven’t had chickenpox before.

If You Get The Shingles Vaccine Does This Mean Youre 100% Protected From Getting Shingles

No. Just like most vaccines, getting vaccinated with a shingles vaccine doesnt provide 100% protection from disease. However, getting the shingles vaccine reduces your risk of developing shingles.

Even if you do develop shingles, youll be more likely to have a mild case. Also, youll be much less likely to develop postherpetic neuralgia, a painful condition that can follow a shingles outbreak.

Recommended Reading: Can You Get Herpes On Your Leg

Treatment Of Postherpetic Neuralgia

PHN is difficult to treat and often resistant to the current pharmacologic therapies. A multimodal analgesic treatment approach should be performed achieving both the efficacy and the tolerability of the therapeutic regimen . Currently, Food and Drug Administration -approved therapies for the treatment of PHN are the transdermal lidocaine and capsaicin patches, gabapentin, and pregabalin. Therapies often use off-label or over-the-counter medications for PHN include tricyclic antidepressants , selective serotonin reuptake inhibitors , opioids, antiepileptics, and nonsteroidal anti-inflammatory drugs . The dosing regimen and adverse effects of treatment options for PHN are summarized in Table 2.

Summary of treatment options for pain management of post-herpetic neuralgia.

PO, per oral, IV, intravenous.

Epidemiology Of Herpes Zoster And Phn

The incidence of herpes zoster and its direct relationship to age has been estimated from prospective and retrospective population studies. There is no indication that the incidence has fallen with time but there are reasons to expect the converse. Increasing longevity and rising numbers of patients who are immunocompromised, either because of disease or therapy , may be expected to increase the incidence of herpes zoster. The impact of child and adult vaccination against varicella-zoster virus on the prevalence of herpes zoster and PHN remains to be determined, although epidemiologic investigation of US sentinel sites shows a clear reduction in the incidence of varicella with universal childhood vaccination

An early UK study demonstrated an incidence of herpes zoster of 3.4 per 1000 population per year, with a direct relationship to age such that the incidence in those in their eighth decade of life was 10 per 1000 per year . A US survey conducted at a similar time reported an incidence of 1.31 per 1000 , but more recent figures indicate that the overall incidence has risen to 2.9 per 1000 . The annual incidence of herpes zoster was recently reported to be 4.6 per 1000 in Iceland and 4.8 per 1000 in France

Don’t Miss: Mouth Herpes Over The Counter Treatment

Financial Impact Of Zoster

Although data for the actual costs of management of both herpes zoster and PHN could theoretically be collected for different health care settings, at present most estimates involve some form of mathematical modeling. The cost of failure to prevent PHN is significant for both patient suffering and health care costs

Estimates of disease prevalence and evaluation of disease management from specialist centers permit estimates of lifetime and episode costs. Several authors have estimated costs of managing PHN from a UK national health care perspective. In the United Kingdom in 1994, the lifetime cost of managing PHN was estimated to be £770 per patient. Annual national spending on PHN was estimated to be £4.8£17.9 million . A more recent study estimated the total cost of treating herpes zoster in England and Wales at £47.6 million or about $69.2 million . Over £32.6 million was estimated as attributable to acute zoster and £15 million to management of PHN. Other costs associated with PHN in the United Kingdom and United States include antiviral drugs prescribed in primary care of the acute zoster, hospitalization , and physician consultations

Clinical Manifestations And Diagnosis

HZ is characterized by unilateral painful vesicles in the affected sensory ganglion. The pain from HZ is described as burning, throbbing, paresthesia, dysesthesia, and itching. The most commonly affected site was found to be the thoracic region, followed by the ophthalmic branch of the trigeminal nerve .

Seventy-five percent of patients with HZ experience prodromal symptoms including pain, general malaise, fever, and headache, which usually begin a few days before the rash develops. Although many clinicians have tried to distinguish acute herpetic neuralgia from chronic herpetic neuralgia, there is no definite consensus on the definition of PHN. However, from the recent studies, it appears valid to define three phases of pain following HZ: acute herpetic neuralgia, defined as pain that occurs within a month after the onset of rash subacute herpetic neuralgia, defined as pain that occurs from the acute phase of HZ to the chronic phase of PHN and PHN, defined as pain that persists beyond three months after rash appearance. It was found that PHN that continues six months after the onset of rash is more likely to be obstinately persistent for several years . Therefore, such pain can be considered “well-established” PHN .

The natural progression of herpes zoster and postherpetic neuralgia .

Also Check: Can You Get Tested For Herpes At The Emergency Room

How Common Is Postherpetic Neuralgia

Varicella-zoster virus causes both chickenpox and shingles. About 99% of Americans over age 40 have had chickenpox. About one in three people in the U.S. develop shingles in their lifetime. Some 10 to 18% of people who get shingles will develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles.

What Causes Postherpetic Neuralgia

Postherpetic neuralgia results from damage to nerve fibers during shingles infection. The nerve fibers at the skin in the affected area send exaggerated pain signals to your brain. Postherpetic neuralgia means nerve pain after herpes. Shingles is also called herpes zoster.

Shingles is caused by the varicella-zoster virus, the virus that causes chickenpox. Once youve had chickenpox, the virus remains in your body for your entire life, but is dormant or silent for years. When the virus becomes reactivated, it causes shingles. A certain percentage of people who get shingles develop PHN.

You May Like: How To Treat Painful Herpes Sores

Effect Of Phn On The Patient

The impact of PHN falls on patients, their caregivers, and on health care providers. The burden includes both personal suffering and use of health care and social or community support resources. The quality of the pain when examined by using the McGill pain questionnaire was described by patients as tender, burning, throbbing, stabbing, shooting, and/or sharp. Allodynia, or pain following stimuli not normally overtly painful, is described by a majority of patients . Patients with prolonged PHN often have ongoing disturbances in physical and psychosocial functioning . In severe cases, PHN can lead to drug dependency, depression, and even suicide

The Nottingham Health Profile , a generic health-related QoL measure, was used to assess the impact of herpes zoster on overall health status, including patients energy levels and ability to sleep . Herpes zoster rash severity was significantly associated with pain, impairment of physical mobility, and sleep, but the correlations were not large. Herpes zoster pain, measured at week 8, correlated best with the QoL variables, and had a significant association with all of them. The NHP dimensions that correlated most significantly with herpes zoster pain measures were pain , energy , and sleep . The impact of pain at week 8 was similar to days 14 and 30 and was higher than the impact from week 12 onward