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Shingles: How to avoid it and how to cope with the pain



Thanks for joining our Jan. 26 live chat on shingles, a viral infection that affects more than 1 million people a year. Anyone who's had the chicken pox can get the painful rash, though senior citizens are more at risk. Dr. Paul Christo, director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine, will answered questions on how to protect yourself against shingles and how to cope with the pain. Read the transcript below.

Find more live chats on a variety of health topics from national experts here.

Note: Comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

 Health Chat: Coping with shingles(01/26/2011) 
11:27
Baltimore Sun Health: 
Hi, we're going to be starting our chat around noon, but feel free to add your questions now.
Wednesday January 26, 2011 11:27 Baltimore Sun Health
11:59
Baltimore Sun Health: 
Hi, welcome to our live chat on shingles. We have Dr. Paul Christo, director of the Multidisciplinary Pain Fellowship Training Program at Johns Hopkins University School of Medicine. We will try to get to as many questions as possible within the hour, answering on a first come, first served basis. We did get quite a few in advance and we'll try to combine some that are similiar.
Wednesday January 26, 2011 11:59 Baltimore Sun Health
11:59
drchristo: 
HI, Welcome to the web chat on pain. Happy to take as many questions as possible during the hour.
Wednesday January 26, 2011 11:59 drchristo
12:00
[Comment From MichelleMichelle: ] 
Hello Dr. Christo, Here is a few shingles questions for you; 1. I did have chickenpox as a child. Why have I had shingles (3) times ? Each outbreak was on the same nerve beside my left shoulder blade.2. Is there a minimum age that a person can receive the shingles injection ?3. How can you ease the pain, even after the spots have gone away ?4. Will the shingles injection stop you from having another outbreak ?Thank you for taking the time to answer.
Wednesday January 26, 2011 12:00 Michelle
12:01
drchristo: 

We know that shingles can occur again at about the same rate as those who haven’t had shingles at all. The virus that causes shingles (herpes zoster) lives in a sensory nerve in the body. The virus often remains controlled by our immune system until we age or until our immune system becomes weaker. Stress is often a trigger to the activation of the virus in our bodies.

The shingles vaccine is called Zostavax and itżżżs been available in the US since 2006. A very large study looked at over 38,000 people who either received the vaccine or did not. Those people who were given Zostavax had a greater than 50% reduction in the risk of developing shingles (herpes zoster) and a 66% decrease in the risk of further developing persistent and long lasting pain from shingles called postherpetic neuralgia (PHN). This large study was done in patients age 60 and over, but experts say that if you are 50 years old or greater, you are eligible to receive the vaccine based on a recent study in this age group.

If the pain persists for approximately 4 months after the rash heals, itżżżs believed that the pain syndrome called postherpetic neuralgia (PHN) has developed. The FDA has approved three drugs to treat PHN: gabapentin (neurontin), pregabalin (lyrica), and a lidocaine patch (lidoderm) that is worn on the skin. These can be effective in reducing the pain and skin sensitivity associated with PHN. Other medications can also help. If mediations donżżżt relieve enough of the pain, a treatment called spinal cord stimulation can be helpful. Nerve blocks can be helpful when shingles first occurs and are less helpful if PHN develops.

Weżżżre not sure if the vaccine called Zostavax will prevent further outbreaks of shingles because there are no studies to document this. For instance, if youżżżve had shingles already, the recommendation is to get Zostavax because it still may help prevent further outbreaks even though we donżżżt have studies that prove this to be true. Because the risk of recurrence of shingles is about the same for somebody whożżżs already had it than it is for somebody who has not had shingles, the recommendation is to get the vaccine. The vaccine has very few side effects if you are healthy (if your immune system is working normally) and the belief is that it may be of benefit in reducing the risk of developing shingles again.

Wednesday January 26, 2011 12:01 drchristo
12:02
[Comment From PamelaPamela: ] 
Is there any value in receiving the shingles vaccine after a single episode of shingles? What is the recurrence rate for shingles? What role does stress play as a trigger for shingles in both the vaccinated and unvaccinated populations?I recently experienced an initial bout with a light but widespread rash on my left torso which took 3 months to completely clear. Age 63, unvaccinated, severe chicken pox at age 7 Thank you
Wednesday January 26, 2011 12:02 Pamela
12:03
drchristo: 
There may be benefit to receiving the shingles vaccine (Zostavax) after having had shingles for the reasons I mentioned earlier. The recurrence rate for shingles is about the same as it is for somebody who has never had shingles. This is the reason that it is now recommended that the vaccine be given even if youżżżve already had shingles. Itżżżs unusual for the rash to take 3 months to clear. The herpes zoster rash and vesicles usually clear in 7-10 days and then sometimes produce a scar or changes in the color of the skin.
Wednesday January 26, 2011 12:03 drchristo
12:04
[Comment From WendyWendy: ] 
My father, mother, grandmothers all suffered from shingles - my mother and maternal grandmother's shingles was particularly debilitating, as it was located primarily on their face and head. Am I likely to get shingles because of my genetic disposition? (and yes I have had chicken pox) I am 58 - and would like to get the shingles vaccine. My doctors told me to wait until I am sixty. However my relatives have had shingles before they were sixty. Can I make a case?Are there any side effects from the vaccine?
Wednesday January 26, 2011 12:04 Wendy
12:05
drchristo: 
There may be some genetic link to shingles, but weżżżre not sure. It is clear that things like older age (especially 60 years and older), more severe pain with shingles, a more severe rash, and stress are risk factors for developing persistent pain (postherpetic neuralgia). There is evidence to support the use of the vaccine (Zostavax) for people 50 years of age and older even though the large study on Zostavax included people 60 years and older. The data show that even if you are 50 years of age or older, there is reduced risk of developing herpes zoster and postherpetic neuralgia (PHN). The vaccine should not be given if you are allergic to certain components of the vaccine, you have HIV/AIDS, have had leukemia or bone marrow cancers, or you are on therapies that weaken your immune system. Side effects of the vaccine are minimal if your immune system is functioning normally. You may experience some irritation and redness at the site of the vaccine.
Wednesday January 26, 2011 12:05 drchristo
12:06
Baltimore Sun Health: 
While we're on the topic of vaccines, a recent Kaiser Permanente study suggests the shingles vaccine reduced the incidence of painful outbreaks by 55%, even in the oldest populations.
http://www.baltimoresun.com/health/la-he-shingles-vaccine-20110112,0,3450405.story
Wednesday January 26, 2011 12:06 Baltimore Sun Health
12:06
[Comment From EstelaEstela: ] 
Is an individual whose family members had shingles (grandfather, mother) more apt to get shingles when they are older/senior? Would you recommend that individual to get the shingles vaccine? My husband's grandfather had very painful shingles for 4 years, eventually passed away after falling out of bed. My husband got the chicken pox at age 18 and his mother developed shingles for about a month at the same time. (I thought chicken pox was a childhood disease, is 18 y.o. late in the game for chicken pox?)
Wednesday January 26, 2011 12:06 Estela
12:09
drchristo: 
There is a 20-30% risk of developing shingles (herpes zoster) during life which is significant. Almost 50% of shingles cases occur in those 60 years of age and older. This risk of getting shingles increases even more as we live beyond 60. The chances of developing persistent (PHN) pain also increase beyond age 60 and by age 80, there is a 20% risk of developing PHN! This pain can be severe, burning, stabbing, and can result in extreme skin sensitivity. Some patients cannot tolerate wearing bras, undershirts, the wind blowing on their skin, or even water touching their skin. I would recommend the vaccine (Zostavax) in older adults because Iżżżve seen how life changing PHN can be on those suffering from chronic PHN pain. Chicken pox (varicella zoster) is a childhood illness typically. People tend to get sicker if they get chicken pox when theyżżżre over 20 years of age. Since 1995, the US has offered a vaccine against chicken pox (Varivax).
Wednesday January 26, 2011 12:09 drchristo
12:09
[Comment From KevinKevin: ] 
A few questions about shingles:- Does having it once have any implications for getting it again, good or bad?- Is the vaccine's effectiveness affected by previous episodes of shingles?- Is the virus contagious during a shingles episode?- Does the vaccine require periodic booster shots?- Can the vaccine itself cause the patient to become contagious?- I know someone who just developed "traumatic shingles", an episode of shingles caused by an injury. Can you speak to this?Thanks!
Wednesday January 26, 2011 12:09 Kevin
12:13
drchristo: 
Having shingles once just means that you are probably at the same risk (maybe lower) of developing shingles (herpes zoster) again as somebody who never had shingles at all. Weżżżre not sure whether the effectiveness of zostavax is affected by having had shingles. In acute herpes zoster (during a shingles episode), that person is contagious. The virus can be transmitted through the skin or even through respiratory droplets. So far, the zostavax vaccine does not have a booster. Zostavax should not make the person contagious unless he/she has a weakened immune system (immunocompromised). If a family member is immunocompromised, then the person vaccinated with zostavax could transmit the virus to that family member. Stress is a risk factor for the development of shingles, especially things like a death in the family or divorce for instance. Itżżżs possible that a traumatic injury can lead to stress which in turn can lead to shingles.


Wednesday January 26, 2011 12:13 drchristo
12:13
[Comment From JohnJohn: ] 
Malw, age 80 with postherpetic neuralgia in one eye for 16 months, treated continuously with prednisilone drops without benefit. Any suggestions?
Wednesday January 26, 2011 12:13 John
12:13
[Comment From JohnJohn: ] 
P.S. Have tried all the new antidepressants, such as Cymbalta, Lyrica, Neurontin, etc., without benefit.
Wednesday January 26, 2011 12:13 John
12:14
Baltimore Sun Health: 
If you're looking for further info on shingles, here are a couple of useful websites: http://www.nlm.nih.gov/medlineplus/shingles.html
Wednesday January 26, 2011 12:14 Baltimore Sun Health
12:14
Baltimore Sun Health: 
http://www.ninds.nih.gov/disorders/shingles/shingles.htm
Wednesday January 26, 2011 12:14 Baltimore Sun Health
12:15
Baltimore Sun Health: 
This one is a PDF: http://jama.ama-assn.org/content/305/2/212.full.pdf
Wednesday January 26, 2011 12:15 Baltimore Sun Health
12:18
drchristo: 
You may want to consider the older group of antidpressants that have evidence of good pain relief in PHN called the tricyclic antidepressants (nortriptyline) at low doses. Consider tramadol as well which has been studied in PHN. Lastly, a long acting opioid (long acting morphine, long acting oxycodone, fentanyl patch) may be helpful.
Wednesday January 26, 2011 12:18 drchristo
12:18
[Comment From JeanneJeanne: ] 
I will turn 60 on July 31st this year and did have chicken pox as a youngster. I very much want to get the shot for shingles, but my primary care physician does not administer vaccines of any kind, except for the flu shot. I am a State employee who is covered by Blue Cross/Blue Shield health insurance and would like to know where I may get the shot for Shingles.
Wednesday January 26, 2011 12:18 Jeanne
12:19
[Comment From JennyJenny: ] 
I had shingles 7 years ago. When I am very tired, I get several needle-like pains in legs/feet, mild headache where shingles was (forehead, eye) & onset of fatigue. Am taking Lysene. Anything else that can be done?Jenny
Wednesday January 26, 2011 12:19 Jenny
12:21
Baltimore Sun Health: 
@Jeanne, I've seen a lot of pharmacies advertising that they have the shingles vaccine. Check to see if they work with your insure. Cost is over $100. Also, Dr. Christo things Johns Hopkins geriatric program may offer it. Again, check with your insurance. http://www.hopkinsmedicine.org/geriatrics/
Wednesday January 26, 2011 12:21 Baltimore Sun Health
12:22
drchristo: 
If the sensations occur frequently, I would suggest using a medication for pain such as pregabalin (lyrica), gabapentin (neurontin), or one of the tricyclic antidepressants mentioned earlier. You could also consider tramadol intially and take it 3-4 times a day as needed.
Wednesday January 26, 2011 12:22 drchristo
12:24
[Comment From DonaldDonald: ] 
Hello, My name is Donald and I am 13. I for several years now have been diagnosed with shingles every 1 to 3 Months. ( For the record Chickenpox and shingles aren't the same disease, but the same virus causes them: Varicella zoster [source: Mayo Clinic]. While it's rare for an adult to get chickenpox, both children and adults can get shingles -- but only if they've already had chickenpox.) But here is the problem. I HAVE NEVER HAD CHICKEN POX IN MY LIFE! I have had exema (pronounced X ah ma ) Now it is defiantly Shingles or Varicella zoster Virus. I am concerned about 2 things. 1) Why am I getting them as a Child which is rare as it is. 2) Why am I getting shingles every 1 to 3 months when for most people they happen 1nce in their lives? This is a mystery and I want to know IF I have been Mis-Diagnosed and possible something small and SUPER rare that like 1 in a million people get because This is super rare that this is occuring and I want some kind of explanation. (Also if it helps since getting shingles my immune system white count has not dropped out of normal but boarderlines normal and low. Thanks) I have shingles right now and got them 1 month ago to this day.If you could answer this I would just be awed in amazement. I want the truth if it is a misdiagnosis. Or why is this occurring and How rare is this. 1 in 10. 1 in 100. 1 in 1 Million?
Wednesday January 26, 2011 12:24 Donald
12:28
drchristo: 
It is very rare for somebody age 13 to develop shingles unless they have a weakened immune system (HIV, leukemia for instance). Also, if you haven't ever had chickenpox, then the virus doesn't live in your body, so it can't reactivate later in the form of shingles (herpes zoster). I would consider having a physician who treats shingles examine your rash to determine whether it is shingles or not.
Wednesday January 26, 2011 12:28 drchristo
12:29
[Comment From StevenSteven: ] 
Good Morning,My father has had shingles for over a year & żż, any recommendations for alleviating the pain? He has used about all the medications (Lyrica was latest) & patches that his doctor prescribed to no avail. Any recommendations for the pain would be appreciated.
Wednesday January 26, 2011 12:29 Steven
12:35
drchristo: 
If all medications have provided insufficient relief, I would consider a treatment known as spinal cord stimulation. This involves placing a small wire on top of the spinal cord and using very small doses of electricity to stimulate the cord. It sounds like an extensive procedure, but it really isn't. A trial (test drive) is done first and the wire is placed through the skin under x ray guidance. The patients is awake or in a twilight sleep for the procedure. This stimulation reduces pain and this treatment has shown effectiveness in research studies. If your father's shingles exist in the arm, chest, or legs the stimulator can be considered.
Wednesday January 26, 2011 12:35 drchristo
12:35
[Comment From jean davisjean davis: ] 
Do shingles ever affect speech?
Wednesday January 26, 2011 12:35 jean davis
12:37
drchristo: 
I'm unaware of any speech or language impairments associated with shingles. However, if a person's immune system is weakened (HIV, leukemia, lymphoma) and he/she develops shingles, the virus can spread throughout the body and cause other symptoms.
Wednesday January 26, 2011 12:37 drchristo
12:37
[Comment From GuestGuest: ] 
can shingles spread to a different quadrant or set of nerve clusters?
Wednesday January 26, 2011 12:37 Guest
12:39
drchristo: 
Shingles usually affects a single nerve, but can involve more than one. Shingles usually affects what's called a dermatome (nerve that supplies a certain skin area) in the chest most frequently, then the eye/forehead region next most commonly.
Wednesday January 26, 2011 12:39 drchristo
12:40
[Comment From KoreenKoreen: ] 
I started having symptoms over a week ago, the small rash just appeared today, they say you should start treatment early before 72 hours, does this mean after the rash or at the first sign of pain?
Wednesday January 26, 2011 12:40 Koreen
12:43
drchristo: 
Antiviral therapy (aciclovir, for instance) is ideally started within 72 hours of onset of the rash because most people are not diagnosed before that. There is limited information on starting therapy later than 72 hours, but many experts recommend starting antiviral therapy beyond 3 days of rash onset.
Wednesday January 26, 2011 12:43 drchristo
12:44
[Comment From Dan MuffolettoDan Muffoletto: ] 
How long does the symptoms last. Is it true that some people do not break out ?
Wednesday January 26, 2011 12:44 Dan Muffoletto
12:44
[Comment From Dan MuffolettoDan Muffoletto: ] 
I never break out but the pains get severe and last for months. Is this normal?
Wednesday January 26, 2011 12:44 Dan Muffoletto
12:47
drchristo: 
I'm not aware of patients with shingles (herpes zoster) who don't develop vesicles and a rash that then subside in 7-10 days. I wonder whether you have the condition known as PHN (postherpetic neuralgia) which represents persistent pain or chronic pain in the region of the rash? I would have your primary care doctor or a pain physician examine you and then make treatment recommendations.
Wednesday January 26, 2011 12:47 drchristo
12:48
[Comment From GuestGuest: ] 
I started having shingles when I was about 46 which seems young to me. I did have chicken pox as a youngster. If it is based on a weak immune system or stress, what can I do to prevent further outbreaks. How can I boost my immune system? I get 3 or 4 episodes a year. I get it on the inside of my left breast (yes, I'm female) and I sometimes am worrysome that it is so close to my heart.
Wednesday January 26, 2011 12:48 Guest
12:48
[Comment From barbbarb: ] 
I'm 48 and now have shingles. I'm incredibly healthy and still trying to figure out why this occurred. I'm not stressed (that I know of). Is it possible that it can just occur without some external cause?
Wednesday January 26, 2011 12:48 barb
12:56
drchristo: 
If you are age 50 or greater now, you should consider immunization with the zoster vaccine (zostavax). It's not clear that it will necessarily prevent all of these recurrences, but some experts believe that if may have benefit. Patients with a weakened immune system who can be at increased risk of shingles are usually those with HIV, leukemia, lymphoma, or other bone marrow disorders. These people should not receive the vaccine. Talk to your physician about possible sources of stress or immune dysfunction. It sounds like you are both healthy, so these conditions are not likely. Shingles usually does not affect the heart. The fact that it's located near your breast just means that it's affecting a nerve along your breast.
Wednesday January 26, 2011 12:56 drchristo
12:57
[Comment From connieconnie: ] 
I'm into my 4th week of shingles; the blistering is mostly cleared, but the pain is very bad. I did get the antiviral medicine within 3 days of the outbreak, but apparently it did not help in my case. The meds. I've taken thus far, including Neurontin and then Lyrica accompanied by another Rx painkiller, are not really effective and don't address the severe itching that remains. Any ideas on how do deal with the bad itching? My doctor does not want me to use steroidal cream.
Wednesday January 26, 2011 12:57 connie
12:59
drchristo: 
You could try nortriptyline for the pain and it may also help with the itching. The lidocaine patch is approved for PHN, and helps reduce pain and skin sensitivity.
Wednesday January 26, 2011 12:59 drchristo
1:02
Baltimore Sun Health: 
That's all the time we have for today. We'll be back in 2 weeks with another pain topic. Thanks for joining us. We hope we answered enough broad questions to address everyone's issues.
Wednesday January 26, 2011 1:02 Baltimore Sun Health
1:03
drchristo: 
I hope this session was helpful and thank you for your questions.
Wednesday January 26, 2011 1:03 drchristo
1:06
 

 
 
 
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