All The Shingles Ladies Put Your Hands Up! – The Bottom Line On Shingles, PHN and Back Pain

What is shingles and what are its causes?

Shingles is a viral infection that causes a painful rash. The rash can appear anywhere on the body, but is most often found on the torso.

Shingles is a reactivation of the varicella-zoster virus, the same virus that causes chickenpox. Following the chicken pox, the virus lies “asleep” or dormant in nerve tissue. It never truly goes away though. The virus may “awaken” as Shingles years later. This occurs especially in times of stress or illness.

Who develops shingles?

Anyone who has had chickenpox may develop shingles, but the risk of the disease increases with age. Approximately half of all shingles cases occur in those over 60. Every year about one million Americans develop shingles.

What are the symptoms of shingles?

Shingles usually begins with one week of flu-like symptoms. There may be itching, tingling or pain before a rash develops. The rash itself is often accompanied by an aching, burning and stabbing pain. The pain can be anywhere on the body but most often on the chest and back resulting in severe chest pain and back pain. There are fluid-filled blisters that last approximately seven to ten days and heal within two to four weeks.

Are shingles contagious?

Though shingles itself is not passed from person to person, the virus that causes shingles can be. The risk of a person with shingles spreading the virus is low with the rash covered.

Shingles spreads during the blister-phase of the rash. Once the blisters and rash have crusted over the person is no longer contagious.

People who develop shingles typically only have one episode in their lifetime, though having more than one shingles outbreak is not unheard of. The Centers for Disease Control recommends the shingles vaccination for anyone over the age of 60 to help reduce risk.

How is shingles diagnosed?

Shingles is usually diagnosed based on a history of pain on one side of the body, along with a rash and blisters. A doctor may also take a tissue scraping or culture of the blisters for examination in a laboratory.

How long does a shingles outbreak last?

Shingles typically lasts 4-5 weeks. It begins with the initial reactivation of the virus and onset of symptoms. It ends when crusts of the rash fall off and the pain and the itching stops, and blisters heal. Antiviral medicines, such as valacyclovir and famciclovir, help reduce both the duration and the severity of shingles.

What is PHN?

Some people continue to experience pain even after the shingles rash is gone. The term for this is postherpetic neuralgia, or PHN. The pain from PHN can disrupt sleep, mood, work and other daily activities.

How does PHN develop?

The development of PHN begins with the development of herpes zoster. The onset of PHN symptoms will typically occur three to four months after the herpes zoster rash has healed. PHN can last several months to several years.

What are the symptoms of PHN?

The most common symptom of PHN is pain in the area where the shingles rash occurred. This pain can vary in intensity, from mild to excruciating, and in duration from momentary to constant. Other symptoms include itching and numbness and in rare cases, muscle weakness and paralysis.

What are the risk factors?

There are several factors that put people at a higher risk:

  • Female gender
  • Age over 65
  • Presence of early, painful shingles symptoms
  • More severe rash or significant pain during shingles episode
  • Elevated fever in the acute phase of shingles episode

What is the prevalence of PHN?

1 in 5 people with shingles will develop PHN or 150,000 people in the United Stated each year. This makes it the second most common type of nerve pain in the United States. Second only to nerve pain due to low back pain and on par with nerve pain due to diabetes.

Is PHN preventable?

The shingles vaccine that reduces the incidence of shingles also reduces the risk of PHN.

Are there any treatments for PHN?

There are several treatments for PHN so people do not have to live with the pain after a shingles episode. Treatment includes different types of oral medicines such as:

Anti-convulsants (eg. Neurontin or gabapentin, Gralise and Lyrica);

Anti-depressants (eg. Elavil and Cymbalta)

Topical medicines (capsacin and compounded medicines)

What about treatment for PHN other than medications?

Acupuncture

Epidural steroid injections

Neuromodulation or spinal cord stimulation

Bottom Line:

Shingles is a reactivation of the chickenpox virus causing a painful rash. The virus affects the nerve fibers and skin causing a painful, itching, burning rash. The area of the rash is most often over one side of the chest, abdomen or back. Postherpetic neuralgia, or PHN, is a complication of shingles. The nerve pain persists well after the rash disappears. While there is no cure for PHN, there are treatment options to ease pain and suffering. If you do have PHN, take steps to get your pain management needs taken care of.