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Shingles rash gone, but pain lingers on




 

 

DEAR DR. DONOHUE: Will you please do a column on shingles? I have gone through 12 weeks of the nastiest, worst illness possible. I never hear anything on TV about it. — J.C.

ANSWER: I’ll have another go at shingles. Others probably think I overdo it. But it’s such a common problem of older people that it deserves repetition.

Shingles is the work of the reawakened chickenpox virus that has been asleep in nerve cells ever since a person was infected, usually in childhood. It’s a safe bet to say you were infected even if you don’t recall it; more than 95 percent of adults were.

The rash of shingles usually disappears in two to four weeks. Pain, however, can stay with you. The pain is now called postherpetic neuralgia. In making the trip to the skin, the virus damaged the nerve roots that it crawled down to reach the skin. Pain is a consequence of the nerve injury.

A large number of treatments exist for this aftermath of shingles. One is amitriptyline, whose primary use is relief of depression. It also has pain-relieving properties in doses lower than what’s given for depression. Neurontin (gabapentin) is a seizurecontrol medicine that often is successful in suppressing pain. The extended-release form of this drug, called Gralise, is given only once a day. Lyrica (pregabalin) has had a good record in quieting postherpetic neuralgia.

Lidocaine skin patches, placed on the skin where pain is felt, are another way to ease pain without taking an oral medicine. Lidocaine is a numbing agent. The latest innovation for shingles treatment is Qutenza, another skin-patch medicine. The doctor has to apply this patch, and lets it stay on the skin for an hour. Then the doctor removes the patch, and the effect of the medicine lasts for three months. It is expensive.

In cases where no treatment brings relief, opioids — pain relievers of the morphine family — have a place in treatment, so long as they are supervised carefully by the doctor.

The booklet on shingles explains this problem in depth. Readers can order a copy by writing: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.

©2014 North America Synd.


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