PAIN MANAGEMENT
Dr. Stan Golovac
Pain that accompanies shingles is frequently mistaken for other causes
A VIRAL INFECTION of the nerve roots, shingles (varicella zoster) can be very painful. It often causes a rash on one side of the body, the left or right, and is most common in older adults and people with weak immune systems. The good news is, most people who get shingles will get better and won’t get it again. The pain that accompanies shingles is initially frequently mistaken for other causes, especially if the pain occurs before the rash appears. Because shingles is a condition which may be associated with multiple symptoms and presentations it is often misunderstood. It is my intent to help SpaceCoastMedicine.com readers better understand the cause, signs and symptoms and treatment of shingles.
Why do you have to suffer from shingles? As children, we were all exposed to this same virus that causes chickenpox. After an attack of chickenpox, the virus remains in our nerve tissues and may reappear later in life in the form of shingles. Lucky for most of us, it usually stays inactive or dormant throughout our lives, but approximately 500,000 cases of shingles are seen annually.
In and of itself, shingles isn’t all that bad. It’s what happens to the three percent of shingles sufferers who also experience prolonged pain. Called postherpetic neuralgia, this complication causes severe pain to the area involved in the eruption and may last for months—even years—after shingles heals.
Before it manifests itself, the virus hides in a nerve bundle called the dorsal root ganglia or DRG. Once it leaves the DRG, it follows the nerve path and leaves its mark—a fiery red rash with little pustules. You may first experience a headache, flu-like symptoms, and sensitivity to light, followed by itching, tingling, or pain in the area where the rash may develop. With prompt treatment, the rash usually goes away after about two weeks. If all goes well—and it normally does—the little virus goes back into hiding and doesn’t cause any more problems.
How do you get shingles? You can’t catch shingles from someone else who has shingles. It’s most common in older adults and people with weakened immune systems because of stress, injury, infection, certain medications, and other reasons. Unfortunately, there’s no way to predict who may be affected.
Where are the likely areas that it may affect? Shingles typically affects the chest, on one side only. The next most common place is the face, then the lower back and leg. It can also affect the eye and cause intense pain to the sclera, the white portion of the eye.
What are the first signs of the infection? First comes the rash, then small raised fluid-filled pustules develop. They begin to itch and break open—this is when the virus is most contagious. It is very important to keep the rash covered and not allow anyone to touch the area.
What types of treatment are available? Immediately contact your primary care physician to prescribe an antiviral medicine; an over-the-counter pain medication may also be needed. If the pain doesn’t subside one to two weeks after the rash goes away, you may need to begin interventional therapies. These include a nerve block to interrupt the pain signal from the virus and stronger nerve medications such as Gabapentin (Neurontin), Toprimate (Topamax), or Pregabalin (Lyrica). Used for seizure disorders, these medications block the painful signal that is felt from the viral inflammation in the nerve bundle.
What are the complications? It’s important to seek prompt treatment for this condition to minimize the risk of complications. These include persisting neuralgia or painful nerve sites, scarring where the rash erupted, nerve paralysis, and even encephalitis.
If all else fails and you still have severe pain along the rash area, then interventional procedures can be offered such as Spinal Cord Stimulation or an Intrathecal Pump Delivery System. Many different medications can be used in a pump—types that stop the pain associated with shingles are Bupivicaine, an anesthetic, and Clonidine, a blood pressure medication.
A VACCINE for shingles was licensed in 2006. In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older.
Is there any way to prevent shingles? Anyone who has had chickenpox may get shingles later in life. But the U.S. Food and Drug Administration (FDA) recently approved a vaccine that might help prevent shingles or make it less painful if it does occur. One dose of the shingles vaccine, known as Zostavax, is recommended for adults 60 years of age and older. The FDA does not recommend this vaccine for people who have already had shingles.
For people who have never had chickenpox, the varicella vaccine can help avoid the virus that causes both chickenpox and later shingles. Those with no history of chickenpox should also avoid contact with people who have shingles or chickenpox. Fluid from shingles blisters is contagious, and exposure to it can cause chickenpox (but not shingles) in people who have already had shingles.
Stanley Golovac, MD is the co-director of Space Coast Pain Institutue. Dr. Golovac completed his education at UTESA University in 1985, where he received his Doctor of Medicine. Upon graduation, Dr. Golovac completed his postgraduate training in Family Practice Residency Program at St. Mary Hospital in New Jersey and in the Department of Anesthesiology at Jackson Memorial Hospital in Miami. Dr. Golovac gained extensive clinical experience in anesthesiology, emergency room medicine, and alternative services. He served as Assistant Clinical Professor of Anesthesia at the University of Miami Jackson Memorial Center for several years, and then as a practicing Pain Consultant in the Miami area. He currently utilizes his expertise at Cape Canaveral Hospital/Health First Pain Management and the Space Coast Surgery Center of Pain Management. For more information log on to YourPainInstitute.com
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