Shingles—Coping With the Pain
“The intense pain behind my eye frightened me,” recalls Ann. “I worried that a brain tumor was developing.”
“When I woke up with such unusual discomfort in my side, I thought it must be appendicitis,” Jean remembers.
“I’ve had rashes before,” relates Dilip, “but I wondered why this one hurt so badly under the skin.”
WHAT exactly is shingles? This layman’s term for the disease evidently comes from the old word sengles (meaning “a girth” or “a belt”), which derives from the Latin cingulum, meaning “girdle.” Thus, the word has no association with the shingles that are used on roofs.
Medically it is known as herpes zoster (from the Greek terms herʹpes, which is derived from herʹpo, meaning “to creep,” and zo·sterʹ, meaning “girdle”). In character with the name, the herpes virus that causes shingles crawls stealthily along sensory nerves and frequently girdles the torso with its serpentine trail of painful eruptions. The often agonizing pain of the inflamed nerve can be excruciating, hence the term “exquisite pain” used by some doctors.
Early symptoms of shingles, such as fever, chills, and general malaise, often mimic the flu but may also be mistaken for a heart attack, brain tumor, or some other serious condition. Numbness, superficial tingling, and intense burning or itching sensations progressing to severe, agonizing pain are the most common complaints of the shingles sufferer.
In about a week’s time from the onset of symptoms, a linear stretch of itchy red pimples appears along the sensory nerve network attacked by the virus, usually above the waist and on only one side of the body. Typical locations are on the rib cage, lower back, chest, neck, forehead, or eyes, depending upon the nerve ganglia affected. The rash soon develops into clusters of vesicles, or watery blisters, that look deceptively like poison ivy. In about ten days, these become crusted and begin to fall off, in many cases leaving behind scars and lingering pain as reminders of one’s encounter with shingles.
Causes, Prevalence, and Prognosis
How does one get shingles? The likelihood is that the patient infects himself. Medical researchers have established with virtual certainty that the herpes virus (varicella zoster) that causes shingles is the same highly contagious one that causes chicken pox. This explains why someone who has shingles can cause another (generally a child) to have chicken pox. However, to get shingles, one must first have had chicken pox.
After an episode with chicken pox, usually early in childhood, the immune system does not completely rid the body of the varicella-zoster virus. It travels to a remote nerve center (researchers feel this to be a spinal or cranial area), and there it lies dormant until such time as it finds circumstances favorable for striking again, often years later when the immune system tends to be weaker.
While 10 to 20 percent of the general population get shingles some time in their lives, those most susceptible are over the age of 50. Researchers estimate that half of those reaching age 85 have had the disease. Males and females are about equally affected. The disease can recur, but it is of some comfort to know that only about 2 to 4 percent have a repeat attack.
A bout with shingles most frequently comes after a period of severe illness, unusual stress, prolonged fatigue, or other trauma in one’s life. It may follow chemotherapy, radiation treatment, or other procedures that compromise or weaken the immune system. This second sting by the chicken-pox virus produces, not a recurrence of chicken pox, but shingles, which has some of the general characteristics of chicken pox. These characteristics include stages of rash, vesicles, and crusts, yet shingles is nonetheless a separate disease.
How serious is shingles, and how long does an attack last? While shingles is very distressing, the disease is seldom life-threatening. But once you get it, prepare to endure several weeks of persistent pain as the body builds up defenses to deal with this flare-up of viral infection. The duration of the disease varies from seven to ten days in most cases, although it can take up to four weeks for the eruptions to heal. It is not unusual for shingles patients to be plagued with nerve pain, called postherpetic neuralgia, for a number of weeks, sometimes months, after the vesicles have cleared up.
If the infection spreads to an eye, this can seriously affect eyesight and can cause blindness. So it is advisable to see an ophthalmologist immediately if the area affected is on the face. Early treatment can often prevent serious ocular complications.
What can be done to treat shingles effectively? While many remedies have been tried from ancient times to the present, the honest answer is that medical science has yet to come up with a treatment that does more than slightly modify the effects and control the pain until the disease has run its course.
Recent investigation into the use of antiviral drugs in treating various herpes infections has produced some promising results in treating shingles. Acyclovir, for example, while admittedly not a cure, slows down the replication of the virus and tends to decrease the pain and the duration of the disease in some patients. Researchers say that for best results, treatment should start early.
In a study at the University of Colorado School of Medicine, shingles patients receiving up to 800 milligrams of acyclovir orally five times a day for ten days experienced significantly less lesion formation, scabbing, and pain than recipients who received placebos. Researchers are divided as to whether acyclovir also serves to decrease the severity of postherpetic neuralgia. Vidarabine, another antiviral drug, has had some success in treating shingles. Research is being done on a vaccine, but this is still in the experimental stages.
Many who have had shingles say that the pain would be more endurable if it was not so persistent. Night and day it persists, exhausting the patient mentally as well as physically.
During those days when the patient’s level of pain is very high, doctors may consider giving more potent pain inhibitors for a few days, though these tend to have undesirable side effects. If the patient can bear it, the application of wet cold compresses can be soothing. A topically applied cream with 1 percent silver sulfadiazine applied several times a day has been helpful to some. Leave the blisters alone; do not scratch them or cover them with bandages.
The sores will gradually heal, but for many sufferers there is no letup in pain as shingles strikes its second blow. Postherpetic neuralgia sets in, which is especially debilitating to the elderly and to immunosuppressed patients. Managing this throbbing, stinging pain is difficult. Corticosteroids have been tried, but medical data is inconclusive as to the effectiveness and safety of these powerful drugs. Physicians sometimes prescribe the antidepressant amitriptyline when there is prolonged pain, but this too can compound the problem, especially in long-term use.
Strangely, quite promising results in pain control have been achieved with an ointment containing capsaicin, which comes from the red pepper used to make chili powder. But this cannot be applied until open blisters have healed over. Battling a severe case of shingles, Jean, mentioned at the outset, found relief by wearing a TENS (Transcutaneous Electrical Nerve Stimulation) unit night and day for several weeks. The small electrical impulses disguised the intense internal pain and allowed her freedom of movement.
The list of home remedies is long, most having to do with a wholesome diet (low in arginine) and including supplements, such as vitamins B and C and L-lysine. Some claim benefits from applying apple cider vinegar topically; others use vitamin E to assist in healing the skin eruptions.
The probability is that if you get shingles, it will not be too long before friends far and near will send you unsolicited their favorite home remedies. Some suggestions may help, many won’t. Maybe they will bring you a smile amid your pain. At least your friends cared, and knowing this may do more than their remedies.
So in coping with shingles, the patient and his doctor may be able to do some things to make the attack less severe and to minimize pain. But if your physician says, “It looks like you’re having a bout with shingles,” he may simply say that it is best to try to exercise patience and endurance while the defenses our Creator has incorporated into the body bring the disease under control.