Many people have heard of shingles, and primarily think of it as an type of rash or illness that affects adults. However, you may not know that it is actually related to Chickenpox, even if from many years ago, and can potentially include a painful side effect called postherpetic neuralgia. Deborah Osgood, PA-C, one of Noran Clinic’s Allied Health Professionals, explains how Chickenpox can turn into the Shingles rash, and then into nerve pain.
Postherpetic neuralgia is a painful condition caused by resurgence of the dormant chickenpox (varicella) virus that remains in a person’s nerve cells and then can reappear later as the dreaded shingles rash. Then, it is called varicella zoster. The chickenpox virus is actually a virus in the family of human herpes viruses. Once a person has the chickenpox virus, the virus goes dormant in the sensory nerves of the nervous system and then can reactivate as shingles – a painful rash along a nerve pathway – later in life. It is felt that the reactivation can occur in some people when their immune system is stressed or compromised. Certainly, most people heal up just fine from their shingles rash and don’t have continued pain after it heals, but others – not so lucky – have ongoing pain, referred to as postherpetic (meaning after herpes zoster activation) neuralgia (painful nerve endings). Postherpetic neuralgia thus occurs after the painful swath of blistery shingles rash has healed. This rash can occur in different places on the body, but commonly is found on one side of the torso.
Treatment can include topical lidocaine patches or ointment/cream, medications such as amitriptyline, gabapentin, or pregabalin. Used within 2-3 days of the rash, antiviral drugs can reduce the severity and duration of shingles. Also, if the shingles rash appears on the torso, a nerve block can possibly help ward off the later development of postherpetic neuralgia. Since there is no cure for postherpetic neuralgia, a vaccine has been developed for shingles and is indicated for persons age 60 and over. Like the chickenpox vaccine, it can’t guarantee you won’t get shingles (it reduces the chance in half), but it can reduce the severity of the shingles and the risk of developing postherpetic neuralgia. Since the vaccine contains live virus, it should not be given to people with weakened immune systems, so talk with your health care provider if you are 60 years old or greater and interested in preventing shingles, and possibly postherpetic neuralgia afterwards.
– Deborah Osgood, PA-C
For more information on Shingles and the complication of postherpetic neuralgia, visit the National Institute of Neurological Disorders and Stroke page at http://www.ninds.nih.gov/disorders/shingles/shingles.htm