The chicken-pox
virus you had as a child causes Shingles. After the chicken pox has
cleared, the virus hides inside your body and years later reappears
as a band of angry blisters. This is more likely to happen when you
get old or if your immune system is weakened by steroids, cancer
treatments, AIDS or leukemia. In some people, after the blisters
erupt, the virus enters the nerves resulting in bouts of constant
burning knife-like pain called postherpetic neuralgia. If the virus
enters the eye, it may cause blindness. Postherpetic neuralgia may
eventually ease on its own as the nerves heal and return to normal.
Unlike chicken pox, shingles is not contagious.
Within ten days of the time your
blisters first erupt, your doctor may recommend a course of oral steroids such
as prednisone. The steroids may help reduce the chance of getting post-herpetic
neuralgia. When you have blisters, use a drying solution such as a wet compress
of Domeboro powder or tablets to make them disappear. Drying the blisters may
relieve the pain since the fluid inside contains pain-producing hormones known
as prostaglandins. You may also apply an antibiotic cream to help prevent
infections. If treated in a clinic or hospital, shingles blisters are often
opened and swabbed with an antibacterial and drying lotion. Your doctor may
prescribe silver sulfadiazine cream used to soothe and protect burns.
Take pain relievers, such as
Aspirin or Tylenol. Your doctor may prescribe antiviral drugs such as acyclovir.
If you take the antiviral medication within 24 hours of seeing blisters, you
will heal faster and hurt less. A new ointment called Capsaicin (Zostrix or
Zostrix-HP) may also help the pain of post-herpetic neuralgia by decreasing the
amount of substance P, which sends pain signals to the brain. Capsaicin is the
burning ingredient in red-hot chili peppers. Zostrix-HP is the 'hot' version and
Zostrix is the 'mild' version. Either ointment may give you a funny burning
sensation that lasts the initial couple of days. Wear rubber gloves when you
apply the ointment and keep it out of your eyes. Anesthetic ointment such as
Lidocaine or an anti-itch cream called Zonalon (Doxepin) may also be used to
numb the area of pain. Anesthetic ointments such as Lidocaine or an anti-itch
cream called Zonalon (Doxepin) may also be used to numb the area of pain.
Recently many patients have experienced significant relief from
burning skin or nerve pain by applying specially compounded ointments containing
Ketamine alone or various combinations of Ketamine, DMSO, Neurontin, Ketoprofen
or Clonidine. Ketamine is a drug that given intravenously can produce complete
anesthesia. It is not very popular as it tends to produce hallucinations. These
side-effects are not seen with use of the ointment in the proper doses. Relief
of pain with Ketamine ointment has been comparable or even superior to that
obtained from sympathetic blocks. Anticonvulsant medications e.g. Valproic acid,
Tegretol, Dilantin or Neurontin help treat the pain. Take the medications
regularly. Some of these medications may decrease the production of blood cells
so your physician may have to check your blood every few weeks. Occasionally
some of these medications may produce a skin rash. Other medications that are
used in treating post herpetic neuralgia include antidepressants like Paxil and
strong pain relievers like codeine or Ultram. In addition to medications, nerve
block with local anesthetic, steroids or glycerol may provide good long-term
relief. A side effect of these procedures may be prolonged numbness in the area
of pain. Before any procedure your doctor should explain the risks and benefits
to you. Acupuncture, hypnosis, electrical nerve stimulation and psychotherapy
are helpful in some people.
Call your Doctor
when you first see blisters and if your pain is severe or keeps
you up at night.