AfterShingles.com – Shingles Symptoms, Treatment and Pain Management


Print | A A A

Shingles & after-shingles pain

Treatment

Shingles Treatment Options

If you think you may have shingles, you should talk to your healthcare professional. Receiving medical treatment for shingles as soon as possible can lessen the time you have shingles and lower your risk for postherpetic neuralgia (PHN) or after-shingles pain. Your healthcare professional may prescribe an antiviral medication to treat shingles. Early shingles treatment – ideally within 72 hours of the rash appearing – can decrease both the length and intensity of the shingles outbreak1.

In 2006, a shingles vaccine was approved by the Food and Drug Administration (FDA) and is currently recommended by the CDC for adults ages 60 and older in the U.S.2 A vaccine for preventing infection of the varicella zoster virus (VZV infection), which causes chickenpox, has been available in the United States since 19953.

PHN Treatment Options

Currently, there is no cure for PHN1, and it cannot be prevented in all patients1. Because the virus is no longer present after the blisters dry up, the antiviral drugs used to treat shingles are not useful in patients with PHN4. For some people, PHN may improve over time without treatment, although not common5. However, there are several treatment options approved by the FDA for PHN and PHN pain.

You can take some of these medications by mouth in the form of a pill. There is also one topical option, a lidocaine patch, that you can apply directly to the skin where you feel the PHN pain6. It is important to realize that every PHN patient responds differently to these different treatment options.

FDA-Approved Treatment Options for PHN

You might prefer a topical treatment (Lidocaine pain patch) or taking a pill (Gabapentin, Pregabalin) or both7. It is important to talk with your healthcare professional about your pain treatment options and together you can create a customized treatment plan that is best for you.

Treatments How it Works (Mode of Action)
Topical
    Lidocaine patch 5%		 Local
Provides pain relief directly at the site of PHN pain8
Oral
Anticonvulsants
    Gabapentin
    Pregabalin 		Systemic
Provides PHN pain relief by being taken by mouth and travelling through the body to reach the site of action within the central nervous system910.

Additional treatment options

In addition to oral and topical medications, these other approaches may help you manage your pain. Some options that have been successful in some cases include:

  • Biofeedback
  • Relaxation therapy
  • Spinal cord stimulators
  • Transcutaneous electrical nerve stimulation (TENS)11
  • Capsaicin cream12
  • Ice or cold compresses13
  • Acupuncture14

Be sure to discuss all treatment options with your healthcare professional to determine what works best for you.

Take the Quiz

Calendar
Do you have the facts to identify if you or your loved one suffers from shingles or postherpetic neuralgia (PHN)?

Talk to Your Doctor

Calendar

The PHN Pain Checklist and PHN Pain Management Calendar are tools you can use to help you talk about your pain with your healthcare professional.

Expert's Corner

Calendar
Have a question about shingles or PHN? Our partner physician, Dr. Christopher Gharibo offers answers to common questions he hears from his patients.

Poll

Which treatments have you tried for after-shingles pain? (check all that apply)




Show results

Which treatments have you tried for after-shingles pain?

1
Cure PHN: Your Questions Answered. VZV Research Foundation, Inc. 2004: 1-6. Available at: http://www.vzvfoundation.org/publicdownloads/PHN_Brochure_Feb2004.pdf. Accessed April 6, 2009.
2
Shingles Vaccine: What You Need to Know. Department of Health and Human Services: Centers for Disease Control. Available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-shingles.pdf. Accessed February 20, 2009.
3
Harpaz R, Ortega-Sanchez IR and Seward JF. Prevention of Herpes Zoster: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. 2008; 57(05): 1-30. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5705a1.htm. Accessed April 6, 2009.
4
Galer BS. Advances in the Treatment of Postherpetic Neuralgia: The Topical Lidocaine Patch. Today’s Therapeutic Trends. 2000; 1-20.
5
Pain Management Guide: Postherpetic Neuralgia. WebMD. Available at: http://www.webmd.com/skin-problems-and-treatments/shingles/postherpetic-neuralgia. Accessed February 20, 2009.
6
Galer BS, Jensen MP, Ma T, Davies PS, Rowbotham MC. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the neuropathic pain scale. Clin J Pain. 2002; 18(5):297-301.
7
Argoff CE, Katz N, Backonja M. Treatment of postherpetic neuralgia: a review of therapeutic options. J Pain Symptom Manage. 2004;28(4):396-411.
8
LIDODERM® Complete Prescribing Information. Chadds Ford, PA: Endo Pharmaceuticals; 2008.
9
NEURONTIN® Full Prescribing Information. New York, NY: Pfizer Inc; 2007.
10
LYRICA® Full Prescribing Information. New York, NY: Pfizer Inc; 2004.
11
Schmader K. Postherpetic neuralgia in immunocompetent elderly people. Vaccine. 1998; 16: 1768-1770.
12
Watson CP, Tyler KL, Bickers DR, Millikan LE, Smith S, Coleman E. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clinical Therapeutics. 1993: 15(3) 510-526.
13
Cluff RS, Rowbotham MC. Pain caused by herpes zoster infection. Neurol Clin.1998; 16(4):813-832.
14
Taguchi, Raina. Acupuncture anesthesia and analgesia for clinical acute pain in Japan. eCAM. 2008;5(2)153-158.