Experts Corner

If you have a question about shingles or postherpetic neuralgia (PHN), search here to see if it has been answered. Dr. Gharibo will update these questions and answers regularly to address commonly asked questions.

About Shingles

• What is shingles?
  

  Shingles, also known as herpes zoster, is an outbreak of rash or blisters on the skin caused by the varicella zoster virus, the same virus that causes chickenpox. After chickenpox, the virus can stay quiet, or dormant, in a patient's nerve tissue for years and can flare up again as shingles¹.

• Who can get shingles?
  

  Everyone who has had chickenpox is at risk for shingles; however people age 50 years or older, those with weakened immune systems¹ or those who experience severe stress (e.g., death of a spouse) are more likely to suffer from shingles and PHN².

• Can younger people get shingles too?
  

  Yes. Especially those individuals with weakened immune systems due to HIV or cancer³ and those who have received kidney transplants or bone marrow can get shingles no matter how old they are. Patients taking certain medications, such as steroids to treat arthritis, also are at risk for shingles¹.

• How common is shingles?
  

  Approximately one in three people in the U.S. will have shingles during their life – resulting in around 1 million shingles cases in the U.S. every year².

• Is shingles contagious?
  

  Shingles is generally not contagious; however it can be⁴. Shingles occurs only when the virus in a person's body becomes active¹. Generally, contact with an infected person or your loved one coughing or sneezing will not cause shingles³.

  Contact with a person with shingles could lead to chicken pox in someone who has never had chicken pox or who has not received the varicella vaccine³.

  The main period when your loved one may become contagious is when they develop blisters with clear fluid and the rash covering the blisters has not developed crusts. The virus can spread through the skin of any healthy person (who never had chickenpox in his/her life) that comes into contact with any open wounds/rashes/blisters of the patient suffering from shingles disease².

• Can shingles just go away on its own?
  

  Yes, in otherwise healthy individuals undergoing treatment, shingles may disappear without major consequences in two to four weeks. However, the risk of complications from shingles increases with age, weakened immunity and delayed treatment⁵. You should visit your healthcare professional if you think you may have shingles because prompt medical treatment can lessen the length of time you have the rash and lower your risk for post-herpetic neuralgia (PHN), or after-shingles pain. Specifically, antiviral medication may be an effective treatment for shingles if it is taken within 72 hours after the appearance of the shingles rash¹. In some patients with uncomplicated cases of shingles your healthcare professional may recommend keeping the rash clean, dry and covered and avoiding topical antibiotics².

• If I have had chickenpox, am I more at risk for shingles?
  

  Yes. Shingles is caused by the same virus that causes chickenpox, so you can only get shingles if you have been infected by the virus¹. Scientists do not know exactly what triggers a reemergence of this virus, which is called the varicella zoster virus (VZV), but research is underway to better understand it⁵. Staying healthy, eating a nutritious diet, exercising regularly, getting enough sleep and managing stress levels may help keep the immune system healthy, so that it can more effectively fight off shingles and potentially post-herpetic neuralgia (PHN), or after-shingles pain⁵.

• Can shingles occur without a rash?
  

  Yes, but this is very rare. When shingles occurs without a rash it is called zoster sine herpete. Shingles typically begins with a rash, but, in some individuals, the shingles rash may go unnoticed at first. Patients may experience burning or shooting pain, numbness, tingling, itching, headache, fever, chills or nausea. While the rash almost always follows these symptoms, it may be disregarded or mistaken for something else⁵. Please visit your healthcare professional immediately if you think you may be experiencing shingles symptoms.

• Can I get shingles more than once?
  

  Yes, a person can get shingles more than once. It reoccurs in an estimated one to five percent of patients and it can reappear many years after the first shingles episode. If shingles strikes a second time, it will usually not appear in the same location. Most people who seem to experience multiple episodes of shingles are probably having a recurring infection with a related herpes simplex virus, such as cold sores, and not true shingles⁵.


Shingles Treatment

• What is the treatment for shingles?
  

  Antiviral medications are one of the most commonly prescribed medications to treat shingles. Early treatment with one of these drugs – ideally within 72 hours of the rash appearing – can decrease both the duration of shingles outbreak and intensity¹. One or more pain killers may be prescribed to treat the pain of shingles.

  A shingles vaccine was approved by the FDA in 2006 and is currently recommended by the CDC for adults age 60 and older in the U.S ⁴. Contact your healthcare professional to see if you are a candidate for the vaccine.


About PHN

• What is PHN?
  

  PHN (postherpetic neuralgia), or after shingles pain, is nerve pain that is caused by complications from shingles. PHN pain is caused by injury to the superficial and deep peripheral nerves that occurs during shingles infection¹ and usually occurs in and around the area of the shingles rash¹. However, the area and location of the affected part of the body varies with each individual⁶.

• Who can get PHN?
  

  About one in five people with shingles develop PHN⁷, but the likelihood of shingles complications increases with age. People age 50 or older with shingles have a more than 50 percent chance of developing PHN. People age 80 or older with shingles have an 80 percent chance of developing PHN⁷.

• Is postherpetic neuralgia (PHN) contagious?
  

  No. Once the rash of shingles has resolved, the virus is not contagious¹. The pain is caused by nerve damage during the shingles infection¹.

• What does the pain feel like?
  

  The feeling and intensity of pain varies from person to person, but patients often describe it as burning, aching, sharp and itching⁶ and in some patients this can last months or even years¹. The pain may be constant, episodic or provoked or a combination of all of these¹. Because of PHN, the skin may become sensitive to changes in temperature¹ and the feel of clothing and daily tasks such as bathing, dressing and grooming may be painful⁶.

• Where does the pain occur?
  

  PHN pain usually occurs in and around the area of the shingles rash. However, the area and location of the affected party of the body varies with each individual⁶.

• How long does PHN pain usually last?
  

  The duration of PHN varies widely. In some patients, it can last for months or even years. However, for many patients, the pain will lessen over time. Furthermore, there are a growing number of PHN pain relief options that are proving to be effective for many patients¹. Talk with your healthcare professional to discuss what relief option might be right for you.

• What can be done to reduce the risk of PHN?
  

  Unfortunately, there is no treatment that will definitely prevent the occurrence of PHN. However, studies have shown that antiviral medication taken within 72 hours after the appearance of the rash can lessen the severity and duration of shingles and may reduce the possibility of getting PHN in the future¹. A shingles vaccine was approved by the FDA in 2006 and is currently recommended by the CDC for adults age 60 and older in the U.S.⁴

• Compared to something like influenza, how significant is PHN?
  

  While it doesn't affect as many people as the flu, PHN can be much more devastating because it can impact a person's quality of life to the point that it’s hard to wear clothes or even leave the house, as well as result in severe depression⁸. In addition, the most vulnerable sections of the population-the elderly⁸ and those with reduced immune systems-are disproportionately affected³.


PHN Treatment

• How is PHN treated?
  

  Both oral and topical medications are available to treat the often debilitating pain of PHN (see Treatments for more information). Other non-medication approaches may be useful as well such as relaxation, biofeedback and stress management. Physical therapy approaches such as Transcutaneous electrical nerve stimulation (TENS), a device where electrodes are placed onto the skin and slight amounts of electrical current are produced, may also give temporary relief to some PHN patients⁸.

• Are there any pain relievers I can get without going to a healthcare professional?
  

  Pain pills that you can buy without a prescription probably are available, but the effectiveness of acetaminophen, ibuprofen or naproxen in the treatment of PHN has not been proven significantly effective. Anecdotal information on these drugs has shown they rarely produce significant pain relief in PHN⁹.

  Some patients use capsaicin cream, which is sold without a prescription as a pain reliever for arthritis; however, it is made from hot peppers, so it may cause an additional severe burning sensation, worsening of the pain and may not be effective¹¹¹⁰.

• Is there anything besides medicine that will help with the pain?
  

  Some patients with PHN get short-term pain relief by putting ice on the painful region⁷. Be careful not to keep the ice on for more than several minutes, because it can cause skin damage.

  People with constant pain often find that stress reduction techniques may help, including meditation, deep breathing exercises, guided imagery and biofeedback. You can learn these stress-reducing techniques at a clinic specializing in pain management. Transcutaneous electrical nerve stimulation (TENS), a device where electrodes are placed onto the skin and slight amounts of electrical current are produced, may also give temporary relief to some PHN patients⁸.

• Should we try hot or cold compresses?
  

  Cold compresses may ease the pain of shingles or PHN ⁷; however, some people with PHN cannot tolerate cold temperatures on their skin.

• What can I do to reduce postherpetic neuralgia (PHN), or after-shingles pain at home?
  

  Putting firm pressure at the site may temporarily reduce your PHN pain. Keeping the painful area firmly pressed against a chair back, or keeping a purse clutched tightly against the chest can help some patients relieve pain. Cooling the skin with ice or a cool, wet cloth helps some people, but others prefer warm compresses. Some patients may modify their clothing, by cutting holes around the areas in pain to prevent contact with the skin⁷. Given that PHN pain affects every patient differently, pain relief methods will vary too. Please talk with your healthcare professional about others way to help reduce PHN pain.

• If the medicine isn't helping, should we go to a different healthcare professional?
  

  Tell your healthcare professional if the medicine isn't helping. Another type of treatment may help. Your healthcare professional also may refer you to a specialist such as a neurologist or pain specialist. Try to find a healthcare professional who has experience treating PHN. Most pain specialists believe that the vast majority of PHN patients can get meaningful pain relief with the medications currently available.

• Will acupuncture help?
  

  Acupuncture has not been shown to help the pain of shingles or PHN. However, there are non-scientific reports of some patients with PHN getting relief from acupuncture¹².


Caregivers

• How do shingles and postherpetic neuralgia (PHN) affect caregivers?
  

  PHN or after-shingles pain can have a significant impact, ranging from depression to the deterioration of a loved one's lifestyle⁸. It is important that caregivers recognize the symptoms of this silent pain as there may not be visual cues on the patient’s body signaling there is a problem. Take note of changes in activity level, decreased interaction with family and friends, changes in appetite, an increase in time spent sleeping and alterations in overall mood, as all can be signs of serious medical conditions, including PHN.

  As a caregiver, you should also pay attention to your own needs because shingles and PHN can be difficult for both you and your loved one. Caring for a loved one can be rewarding, but it may also take a toll on your own health and well-being, both emotionally and physically. Don’t be afraid to take breaks and ask for help when you need it. Pay attention to your sleep and diet and don't let either one suffer. Keep up your exercise routine or start one. And seek out local support groups. Finding others living with similar situations, whether caregiver or patient, will help you and your loved one know you are not alone


Resources

• Who can I turn to for more information?
  

  Your healthcare professional's office is the first place to go for more information and help. Call for an appointment today.

• Where can I get more information about pain management?
  

  Visit the Resource Center on AfterShingles.com for links to additional resources.


Webinar Questions/Answers

• My 22-year-old, healthy college student had shingles on her lower back twice in the past year. I'm sure it was partially stress related. I didn't know younger people could get shingles. Can people under the age of 60 get the shingles vaccination from their primary care physician (PCP)?
  

  Young or old, anyone infected with the varicella zoster virus can have a recurrence of the viral infection and get shingles ¹, but the shingles vaccine is only indicated for patients 60 years of age and older ¹³. Talk to your physician about whether the vaccine is an option for your daughter.

• I am 60 years old, have had postherpetic neuralgia (PHN) for six years and have been in chronic pain almost every day. I take multiple medications and have some good and some bad days. Is it normal for the pain relief to be inconsistent?
  

  It is always important to talk with your physician, preferably a pain specialist, about your pain. Inconsistent relief is called “breakthrough” pain because it is not being controlled by your usual treatment regimen. Fortunately, there are many medication options and combinations (pill and non-pill) for you that can decrease the frequency and the intensity of your breakthrough pain.

  Visit the Treatment section of AfterShingles.com for more information on some of the relief options currently available. You can also download a chart to help you track and identify the location of your pain from the Pain Management Resources section of AfterShingles.com. Take this chart with you to your appointments to help discuss your pain with your physician.

• I got shingles two months ago and the blisters lasted for two weeks. I am still very exhausted and can only do things for about 4 hours a day, then have to rest, but I have been forcing myself to go swimming every other day for about 30 minutes. How long do you think this tiredness will last?
  

  Stay motivated. Swimming is a great idea. Keep at it. Your energy level should return. You may have become out of shape while you had the shingles and after-shingles pain. Talk to your primary care physician about your persistent fatigue. It is probably unrelated to PHN, but may have been caused by the lack of exercise during that period. Although shingles cannot be prevented at this time, staying healthy, eating a nutritious diet, exercising regularly, resting adequately and controlling stress may help keep the immune system healthy. In turn, the chances of avoiding or recovering from shingles may increase ⁵.

• What is the likelihood of having a second attack of the virus?
  

  The likelihood of a second attack of the virus may be as high as 5%⁵.

• Since herbs are foods (and not manufactured prescriptions) they have less "so-called" side effects. Are there any herbs or supplements (like Vitamin C) that are recommended for shingles or after-shingles pain? Or can the pain be managed through a healthy diet, such as avoiding caffeine and refined sugars, which can cause inflammation and exacerbate pain?
  

  There are no herbs or diet specifics that I would recommend for shingles or after shingles pain, other than to maintain a balanced diet and proper fitness to maintain an optimized immune system ⁵.

• Are the oral medications used to treat after-shingles pain compatible with anti-depression medicine that might be prescribed to the patient?
  

  It depends on the pain medication and antidepressants that the patient is taking. Drug interactions can range from mild to possibly deadly. Maintain a current medication list and discuss options with your physician.

• What is the success rate of not getting shingles if you receive the shingles vaccine?
  

  In clinical trials, the vaccine reduced the risk of shingles by 50 percent. It can also reduce pain in people who still get shingles after being vaccinated ⁴. Talk to your physician about whether the vaccine is an option for you.

• I have been suffering from PHN for six months now. Will I ever be able to get off the meds?
  

  In some patients the nerve takes a longer time to recover and produces prolonged pain while it is healing. The vast majority of patients recover fully from the pain, but it is likely that you'll progressively have less pain over the next 6-12 months and will need little or no pain medication. You may still be left with some numbness, tingling or sensitivity, but this is unlikely to be significant enough to bother you ¹.