None — Shingles
Shingles is the name for a condition caused by the chickenpox (varicella) virus. After the initial chickenpox infection clears, the varicella virus lies dormant in the sensory nerves. Over time, a person can lose immunity to the virus, causing it to reactivate. When the virus awakens, it travels down the sensory nerves to the skin, where it manifests as shingles (herpes zoster).
Early signs of shingles include burning or shooting pain, itching, numbness and tingling. The symptoms are usually limited to a localized area on one side of the face or trunk of the body. Some people also have mild flu-like symptoms, such as fever, chills, headache and weakness or fatigue. Within several days, a rash appears in a band-like pattern over the area. The rash develops into fluid-filled blisters that eventually crust, scab and heal. Patients may continue to have pain, even after the rash has disappeared.
According to the National Shingles Foundation, nearly one million Americans develop shingles annually. Since it is caused by the varicella virus, it only occurs in those who have had chickenpox. Risk for shingles increases with age and most patients are over 50 at the time of diagnosis. People with immune compromising conditions are also at higher risk for developing shingles. A person can't "catch" shingles. However, a person who doesn't have immunity to varicella (hasn't had the illness or received the vaccine) can develop chickenpox when exposed to a patient with shingles.
Post-Herpetic Neuralgia
One of the most common complications of shingles is post-herpetic neuralgia (PHN). This condition is characterized by chronic pain that lasts more than 90 days after the onset of the rash. The pain is caused by damage to the sensory nerves and can be severe and described as burning, sharp, stabbing or aching. Patients often can't even bear the sensation of a light touch (such as from a breeze or clothing). Itchiness and numbness may also persist. People with PHN complain they are unable to sleep or perform regular activities.
The National Shingles Foundation estimates about 20 percent of patients with shingles develop PHN. Researchers report up to 9 percent of patients with PHN are still in pain more than one year after the rash has gone away.
Treating PHN
Investigators estimate the annual cost of treatment for shingles patients is more than $1 billion. The goals of treatment are to alleviate pain and improve a patient's quality of life.
If shingles is diagnosed in early stages, patients may be given antiviral medication. This treatment shortens the duration of viral shedding, blocks the ability of the virus to replicate, and speeds healing of the rash. However, it must be started within 72 hours of the onset of symptoms.
A New Pain Patch
Christopher Gharibo, M.D., Pain Medicine Specialist with NYU Langone Medical Center in New York City, says although there are several treatments for PHN pain, many of the drugs have side effects, like sleepiness, mood changes and nausea. Now there's a treatment, called Qutenza® (kyew-TEN-zuh). Unlike traditional medications, which are usually oral drugs, Qutenza is a patch. It contains the ingredient, capsaicin, which is found in hot peppers. Lower dose capsaicin creams are used to treat other painful conditions, like arthritis.
The Qutenza patch is offered to patients who still have a significant amount of pain after the shingles rash has disappeared. First, the physician identifies the target area of pain. Then, a numbing medication is placed over the skin in that area. The numbing agent is needed because the capsaicin in the pain patch can cause a significant amount of burning pain by itself. After about one hour, the numbing cream is wiped away and the patch is placed on the skin. The patch can be cut to fit a small area. If a larger area needs to be treated, up to four patches can be used.
The patch is left in place for an hour, during which the patient is free to move around the room. Patients are asked to stay in the office in case they have a reaction to or develop side effects from the patch. After the patch is taken off, a special cleansing cream is used to ensure all the medication is removed from the skin. Then, a final cleansing is done with mild soap and water.
Gharibo says Qutenza can be used on patients with shingles pain as soon as the skin heals from the rash. In fact, the earlier the treatment is started, the less pain "imprinting" a patient is likely to have. One important side effect of Qutenza is an increase in blood pressure during the treatment. Gharibo explains the rise in blood pressure is caused by pain associated with capsaicin. That's why a numbing agent is placed on the skin prior to treatment. To ensure the patient isn't having any problems, doctors take blood pressure readings prior to initiating treatment, 30 minutes after the patch has been placed and when the patch is removed. Other side effects of the treatment include skin redness and sensitivity. Gharibo says skin redness typically disappears within a day or two of treatment.
It takes abut a week for the treatment to reach its full potential. However, many patients report a significant drop in pain within a few days. The effects of the patch last up to three months and the treatment can be repeated if needed. Gharibo says Qutenza can be used in combination with other pain treatments.
For information about the shingles pain patch (Qutenza®), click here.
For general information on shingles or post-herpetic neuralgia:
National Institute of Neurological Disorders and Stroke National Shingles Foundation
WSOC
