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If you've ever had chickenpox, your chances of developing shingles increases as you age. That's because shingles is the result of a reactivation of the same virus that causes chickenpox, the Varicella-Zoster virus (VZV). You're probably familiar with the common rash and blisters that develop from a shingles outbreak. But did you know that anywhere from 10-70% of these outbreaks can end with painful nerve damage that lasts anywhere from a few weeks to several months?
The symptoms of a shingles outbreak occur when the latent VZV becomes reactivated in response to stress, aging, or other immuno-compromising conditions. The virus travels from its hiding place (the dorsal root ganglia) in the spinal cord out to peripheral nerves in the skin. This causes a vague burning or painful sensation that later materializes as fluid-filled blisters that burst, crust over, and eventually heal. The whole outbreak usually lasts about 4 to 5 weeks.
Some people continue to feel pain long after a shingles outbreak. They may feel a sharp and jabbing pain, or a deeper ache or burning in the area once affected by a shingles outbreak. Some report headaches, itchy skin, or an extreme sensitivity to touch and temperature changes. Such symptoms lasting longer than 3 weeks after a shingles outbreak is called postherpetic neuralgia or PHN.
The symptoms of PHN are thought to be caused by several things. It could be that when nerves were repaired after the initial shingles outbreak they were done so incorrectly, creating exaggerated impulses which when sent to the brain are interpreted as pain. It may also be that inflammation in the spinal cord caused by shingles causes nerve scarring and long term damage.
There is a clear connection between the development of PHN and age. Those who experience a shingles outbreak over the age of 60 have a 40% chance of developing the condition while those under 60 have only a 10% chance. The length of PHN also appears to increase with increasing age. It has also been noted that those with a distinct prodromal stage (the tingling or burning sensations felt just before a shingles outbreak) had a higher incidence of PHN development. Women also seem to have a higher chance for developing PHN, but it may just be that they report symptoms more often than men.
Because pain is the name of the PHN game, most treatments for this condition are centered on soothing pain. There are a variety of methods for treating nerve pain, some more natural than others. The chronic pain caused by PHN can also lead to depression which can further inhibit immune function and healing. A combination of natural pain relief methods as well as self-help for depression can make living with PHN much more bearable.
Sources:
http://www.fda.gov/FDAC/features/2001/301_pox.html
http://adam.about.com/reports/Shingles-and-chickenpox-Varicella-zoster-virus.htm
http://www.mayoclinic.com/health/postherpetic-neuralgia/DS00277/DSECTION=3
catherine
This article on PHN was very enlightening as we have a patient with these symtoms and doctors have not been able to to make a diagnosis.The lady is in her eighties and had Shingles ten years ago. She has what seens like nerve pain in her arms and legs and had shingles on her back ten years ago. She also has difficultly with standing sometimes and also has bouts of nausea and vomiting which appears to be related to movement. She has just started Gabapentin and has aslo now been prescribed Codeine and Paracetamol combined to help with the pain. If anyone has come across anything similar it would be interesting to hear from you.
Commented on HelloLife September 28 2011 at 4:58 am
catherine
If anyone can give me any more inforation on PHN it would be very useful. Catherine White Catherine@rojene.co.uk
Commented on HelloLife September 28 2011 at 5:01 am
Dr. Jeff Chamberlain, MD
Acouple things about shingles that would be worth adding is that when a person has an episode, it breaks out in only one area of the body (dermatome). The Tash and pain are in the same location. The PHN would be in the same location as the rash. Also the PHN would start at the time of the out break and continue from then, it would not show up later, or in a different location. Getting a shingles vaccine cut she chances of getting shingles in half.
We do not know yet if the chicken pox vaccine will prevent shingles, because it has not been out long enough to see what happens when people become older.
Commented on HelloLife September 28 2011 at 11:40 am
David
This is the first article estimating that the "whole outbreak of Shingles lasts about 4 to 5 weeks". Everything else I have read, suggests 2 to 3 weeks. Since I just finished Day 21 (3 weeks, and YES I am counting!), that means I still have chance that PHN will not be a part of my future? I really hope so! This is really killing me! I haven't had a single full nights sleep in 3 weeks. And I am worried that I am destoying my liver with too much Advil. I guess I better go back to my doctor for a follow-up? I read about accupuncture as a possible help. I am ready to try ANYTHING!
Commented on HelloLife October 18 2011 at 2:11 pm
Dr. Jeff Chamberlain, MD
This is a really good question, here are some definitions and statistics on shingles and Post Herpatic Neuralgia (PHN) that might be helpful:
-Acute Herpetic Neuralgia refers to pain preceding or accompanying the eruption of rash that persists up to 30 days from its onset.
-Subacute Herpetic Neuralgia refers to pain that persists beyond healing of the rash but which resolves within four months of onset.
-PHN refers to pain persisting beyond four months from the initial onset of the rash.
One study showed that about 20% of people who developed shingles still had neuralgia pain 30 days after symptoms began.
While only 10% to 15% of people develop PHN (symptoms lasting 4 months or more) the odds change greatly depending on age. The older a person is, the higher the chance that they will develop PHN (60 to 69 year olds with shingles have a 7% chance of developing PHN, while 80 year olds have a 20% chance of developing PHN). People who have HIV or other significant immune system compromise also have a higher chance of developing PHN.
Also, it is important to know that PHN does not condemn everyone to pain for life. PHN pain in most people resolves over time, with most having complete resolution in less than a year.
Based on these stats, you are still well within the normal rage for your shingles pain. It still might be a good idea to talk to your doctor about treatment options.
Dr. Jeff M.D.
Commented on HelloLife October 18 2011 at 7:56 pm
Erin Froehlich
David - It sounds like Neuroveen might be helpful for you. I have friend here with neuropathy so bad it's hard for her to walk, but she said she's just started using it and it's already helping!
Commented on HelloLife October 19 2011 at 9:34 am
David
Dr. Jeff,
Thank you very much! Your statistics are very helpful. So, technically, since I am just past 3 weeks with Shingles, I am most likely still in the Acute Herpetic Neuralgia stage. I am relieved to know that I am still within the normal range, and that it would be premature for me to think that this will absolutley progress to the PHN stage. It may not. I do have one additional question, and I think you are exactly the right person to know the answer. I have a regular gym exercise schedule, that I have been following for about 20 years now (except for the past 3 weeks, of course). Since this Shingles pain is caused by nerve damage, should I continue to stay away from the gym for awhile? I want to go back, but feel afraid that I might further damage nerves. I am 59 years old, and my outbreak affected one of the dermatomes starting around the middle of my back, and wrapping around the left side to just under my chest. My regular gym workout takes 90 minutes to complete (60 minutes with weights and 30 minutes cardio), and includes 16 different weight machines, each of which concentrates on different parts of the body. Two of them require extreme pressure on my back. One of them requires 410 pound weights, pushing with my legs, and braced with my upper back. The other involves the lower back, so I don't think that one would be a problem. I really don't feel right, not going to the gym, but don't want to cause more problems either. Your advise, please?
Commented on HelloLife October 19 2011 at 12:23 pm
David
Erin,
Thank you for the tip on Neuroveen. I just did some research on it, and since it is completely natural OTC medicine, it seems a perfect fit for me. I won't need to worry about liver damage, as I would with some of the prescription meds. I am going to give it a 3 month try. I'll let you know the results. Thanks again.
Commented on HelloLife October 19 2011 at 12:30 pm
Dr. Jeff Chamberlain, MD
David, once the rash blister crusts over, then the varicella zoster virus is no longer contagious. From a nerve damage stand point. The nerve damage is at a sub cellular level, doing activities that puts pressure on the area my be uncomfortable, but would not cause more nerve damage. There is some evidence that the quicker a person with neuropathic pain gets back to a normal routine, the better they will feel.
Stay Healthy,
Dr. Jeff M.D.
Commented on HelloLife October 20 2011 at 10:09 pm
David
Ok, thanks, Dr. Jeff,
I am going back to the gym tonight!
Commented on HelloLife October 21 2011 at 3:07 pm
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