Herpes zoster reactivation--commonly known as the shingles--is a painful and distressing disease suffered by 1.1 million people per year in the United States who had chicken pox in the past, according to the federal Agency for Healthcare Research and Quality. Most shingles patients are elderly.
Shingles can be prevented altogether with a vaccination known as Zostavax. This is a drug approved by the FDA for preventing shingles and is administered to individuals ages 60 and older who have had chicken pox.
Antivirals
Antiviral medications cannot reduce all shingles symptoms, say Australian physician Anthony L. Cunningham and colleagues in the Medical Journal of Australia, but can help considerably with the pain and rash. Antivirals include such medications as acyclovir, valacyclovir and famciclovir. According to the National Shingles Foundation, it is best if the antivral is taken with 72 hours of the rash.
An antiviral can also reduce the risk for the development of post-herpetic neuralgia--PHN--a severely painful complication of shingles that can last for months or even years.
Antivirals are also used to treat other complications of shingles; for example, according to the National Institute of Neurological Disorders and Stroke, some individuals with shingles may develop herpes zoster oticus, a disorder which affects the ears and can cause vertigo--dizziness--for days. In the worst case, it may cause permanent hearing loss and temporary or permanent facial paralysis.
Corticosteroids
Steroids are sometimes used to relieve shingles-associated pain. Canadian physicians Wim Opstelten and colleagues say an analysis of studies reveals shingles patients taking prednisone--a steroid--are pain-free after a month at more than twice the rate as patients not taking prednisone. However, the steroid did not speed up healing of shingles lesions.
Steroids are also used to treat zoster oticus.
If the eyes are involved, as with herpes zoster ophthalmicus, the individual should see an ophthalmologist immediately. Antiviral tablets or eye drops may preserve eyesight.
Anticonvulsants
Anticonvulsants, commonly used to prevent seizures, are sometimes used to treat the pain of PHN. According to the National Shingles Foundation, studies have found gabapentin reduces the pain of PHN and also enables individuals with shingles to sleep better at night.
Antidepressants
Antidepressants are sometimes used to help with the pain of shingles. Tricyclic antidepressants are usually used because they are sedating and can help the patient sleep better.
Opiates
Opiates have many side effects but when people are in agonizing pain, all they want is relief. In their article in Mayo Clinic Proceedings, Priya Sampathkumar and colleagues note that nonsteroidal anti-inflammatory drugs are often used for painful conditions but they are generally ineffective for pain emanating from shingles.
Sampathkumar notes opioids usually cause constipation and consequently, shingles patients should take stool softeners and laxatives in concert with the opioid.
Lidocaine
Lidocaine is available in transdermal patches for the relief of pain and is FDA-approved to treat PHN. Some doctors recommend capsaicin cream for shingles patients, but this cream burns intensely and because of this side effect, few people with shingles will use it more than once.
References
- Canadian Family Physician: Treatment of Herpes Zoster
- eMJA: The Prevention and Management of Herpes Zoster
- Mayo Clinic Proceedings: Herpes Zoster (Shingles) and Postherpetic Neuralgia
- National Institute of Neurological Disorders and Stroke: Herpes Zoster Oticus Information Page
- Agency for Healthcare Research and Quality: Average Annual Health Care Use and Expenses for Shingles among the U.S. Civilian Noninstitutionalized Population, 2003-2005
