In the Spotlight
After Shingles Pain
Contributed by Dr. Rollin M. Gallagher, MD, MPH; Dr. Robert D. Kearns, Ph.D.; Jack Rosenberg, MD
What is shingles?
Shingles is a painful viral infection. The same virus that causes chicken pox also causes shingles. However, not everyone who had chicken pox will develop shingles. Some people have the virus hiding in their nerve tissue, and if conditions are right, the virus "awakens." This may cause a few blisters on the skin or a big rash that is only on one side of the body. The rash may be on the chest and back, at the waist, on the upper arm, or on the side of the face and scalp. In healthy people, the rash goes away in 2 to 4 weeks. Shingles is not likely to spread, but it may cause chicken pox.
Can shingles be prevented?
A vaccine reduces your risk of getting shingles. Half as many people get shingles after being vaccinated. Among those who are vaccinated and then develop shingles, only one third develop after shingles pain. If you are older you when you are vaccinated, if you get shingles, your outbreak will be less severe.
How do you know when shingles is coming on?
The early signs of shingles can easily be mistaken for another illness. You may be familiar with some of these, such as burning or shooting pain in the skin; a numb or tingling feeling; mild flu-like symptoms; then a rash or cluster of blisters appears. For most people the shingles rash will disappear without major problems. However, 1 in 5 of people who suffer from shingles may develop a complication called after-shingles pain or postherpetic neuralgia (PHN).
What is the treatment for shingles?
Prompt treatment with an antiviral drug decreases the severity and length of time of acute pain. Antivirals work best when taken 24 to 72 hours after the rash appears. Corticosteroids and pain relievers also may provide pain control.
What causes after-shingles pain?
After-shingles pain occurs because the virus that causes shingles damages certain nerves in your body underneath the skin. The pain can last for a long time ¿ even months or years. Severe pain can occur on or around the rash. It is often described as burning, aching, itching, or sharp. After-shingles pain can be so severe that it affects your quality of life, making you feel alone or isolated. If you suffer, or have suffered from after-shingles pain, you are not alone. In the United States, 120,000 to 200,000 people suffer from after-shingles pain each year.
Who is most likely to develop after-shingles pain?
After you have shingles, your chances of developing after-shingles pain increase with age.
If you are age 50 or older, you have a more than 50 percent chance of developing after-shingles pain
If you are age 80 or older, you have an 80 percent chance of developing after-shingles pain
Others at higher risk include those who have felt a pain before the rash appeared. Also at higher risk are those who have had a severe rash within a few days of shingles infection.
How serious is after-shingles pain?
After-shingles pain can be serious. It can lead to depression. It is one of the most common causes of pain-related suicide. It can also appear as hidden pain. While the skin looks normal, incomplete healing can leave nerves under the surface of the skin damaged. Because of after-shingles pain, your skin may become sensitive to changes in temperature. You may also find the feel of clothing painful. Daily tasks such as bathing, dressing, and grooming may be painful. Going shopping, cooking, traveling and sports can also be limited by severe after-shingles pain.
Is there a treatment for after-shingles pain?
The good news is that there is help available. Effective treatment choices, including getting enough rest and taking medications (pain relievers, antidepressants, and other medications), may relieve after-shingles pain. Each medication works differently and has its own likely benefits. It is important for those suffering from after-shingles pain to schedule an appointment with their healthcare provider. When you are getting for that appointment you can write down information that will help your healthcare provider make a diagnosis and decide on the best treatment for you. There are a number of tools such as a pain management calendar, a pain checklist and a talking to your doctor discussion guide to bring with you to your appointment.
One Person's Story
I would like to share with you my experiences with after-shingles pain, so we can better understand the disease. As a child, I had chicken pox. Two years ago, when I was 54, I was diagnosed with Crohn's Disease, an autoimmune disorder. I was started on medication. After two months on this medication my immune system was weakened. The combination of having had chicken pox, being older, and having a weakened immune system put me at risk for developing shingles. I experienced fever, headache, chills, and nausea. After two days, I broke out in blisters on my left side, from my waist to my knee. Because my immune system was weakened, the blisters lasted for six weeks. The pain was like a burn. It was so severe that I could not sleep at night. I was given a low dose of an anti-depressant to help me sleep, and that was very helpful.
After the rash healed I had discolored areas on my skin, which looked like splotches. It felt like I was wearing a blanket of nettles on my left thigh and groin. I could not stand to have elastic touch my skin on the left side. I had to go buy underwear that did not bind around my leg.
My health care provider was wonderful. He recognized the shingles right away and started me on antiviral medication. He warned me I was at risk for after-shingles pain, and reassured me that if I developed that problem, he would provide supportive treatment. When I did experience after-shingles pain, I thought, "at least I know what that is." He offered me the choice of wearing a patch with medicine that would decrease the pain or taking a pill. I found I did not need medication if I got enough rest and was not stressed. It took a year for the pain to go away. Now I encourage everyone who is 60 or older to get the one-time shingles vaccination.
There's a Vaccine for Shingles?! (CDC) (Podcast)
New shingles vaccine (Shingrix) for adults 50 and older (CDC) (PDF)
Shingles & PHN: Your Questions Answered (VZV Research Foundation) (PDF)
Created July 27, 2018