Update on Shingles and Postherpetic Neuralgia

Shingles, also known as herpes zoster (the virus that causes it is the varicella-zoster virus), is an often painful condition that occurs in people who have previously had chickenpox. It is estimated that 95% of all Americans have had chickenpox at some point in their lives. The possibility of developing shingles is quite high, close to 1 of every 3 people who have ever had chickenpox.  Approximately 1 million people per year in the United States develop shingles. It is much more likely to occur in people 50 years old or older, and the likelihood of developing shingles continues to increase with age.

Researchers have identified that after having chickenpox the virus remains “sleeping” in your body for the rest of your life.  For some reason, in certain people, it wakes up and causes shingles. Emotional stress or a weakening immune system can open the door for a shingles attack. In most cases, people can never identify why an episode occurs. When a case of shingles is coming on, it often has some distinct signs and symptoms including:

  • Relatively sudden onset of  a burning type of pain and very sensitive skin on one side of the body or face
  • Development of small blisters in the painful area that turns into a reddened rash, which becomes wet, and then crusted over
    • The rash follows a band-like “path” – it follows the affected nerves on the body
  • Fever
  • Headache
  • Fatigue
  • Chills

It is important to remember that shingles is contagious.  It is possible to infect a child or adult who has not yet had the chickenpox, with a case of chickenpox.  Just like chickenpox, shingles is generally contagious before healing or crusting of the blisters takes place. This is especially important for women who are pregnant who have not had the chickenpox, as getting chickenpox can be dangerous for the unborn baby. People who have already had chickenpox, cannot catch shingles from someone with shingles.

Sometimes the pain associated with the rash does not go away when the rash does.  This condition is called Postherpetic Neuralgia (PHN).  This means that after the episode of herpes zoster goes away (Postherpetic), the nerve remains very painful (Neuralgia). This is the most common complication of shingles. The pain associated with PHN can be very disabling, and dramatically affect someone’s ability to perform their activities of daily life. The pain can sometimes be so severe, that wearing clothes or even using bed sheets can cause excruciating pain.   It can be difficult to eat or, sleep and lead to irritability and even severe depression.

PHN pain can last months, and sometimes even years. Although there are medications specifically approved by the Food and Drug Administration to treat it, it may be very tough to make the pain go away completely. The drugs usually target the pain, but not the cause of the pain. If used early (within 1 to 2 weeks of the rash beginning), antiviral medications may make the shingles attack less severe, and may decrease the likelihood of developing PHN. Therefore, it is very important to seek medical attention if you think you have shingles.

In 2006, a vaccine was developed that cut the chance of getting a case of the shingles in half. The vaccine is approved for use in adults 60 years of age or older. This is the population at highest risk. The vaccine has also been shown to be very effective in reducing the severity of a shingles attack when it does occur, and it also reduces the number of cases of PHN.  Other research is exploring the benefits of vaccination for people younger than 60. The current Centers for Disease Control recommendations are that all people over the age of 60, who are not at risk from side effects of the vaccine, should be vaccinated. People with poor immune systems, such as those with HIV, receiving chemotherapy, or organ transplant recipients, should not get the vaccine, as it contains active virus.

An article in the Journal of the American Medical Association in January 2011 noted that despite its likely benefit, the routine use of the shingles vaccine still remains low.  Only around 10% of people age 60 and over have been vaccinated.  The authors suggested that there are many reasons for the low rate of use of the vaccine. The most likely reasons may be the lack of awareness of the vaccine (by both health care providers and patients), the fact that it is relatively new, and the cost.  The vaccine costs around $200.00 and it is not covered by all insurance plans.  Although all Medicare Part D plans do cover the vaccine, other Medicare plans do not.

It is very important to be aware of shingles and its possible consequences, such as PHN. It is important for you to ask your health care provider whether you should receive the vaccine, and what treatments are appropriate if you develop shingles, in order to decrease the chance that it will become Postherpetic Neuralgia.