Up to 90 percent of Americans test positive for infection with the herpes simplex viruses that cause cold sores, University of Washington Professor Lawrence Corey reports in the 2008 edition of "Harrison's Principles of Internal Medicine." While most people experience symptoms so mild that they don't even realize they are infected, about 30 percent of people experience the painful, blistering lesions popularly known as cold sores. Antiviral drugs can help reduce the duration and severity of cold sore blisters, but separate treatments are required for pain.
Types
Cold sore blister pain rarely merits prescription or invasive pain treatment. The American Dental Association recommends topical local anesthetics, such lidocaine, benzocaine or tetracaine. Some patients report relief from products that contain camphor or benzyl alcohols. When topical medications aren't enough or when cold sores are accompanied by systemic symptoms such as fever or headache, the American Academy of Family Physicians recommends oral medications, such as aspirin, acetaminophen or ibuprofen.
Use
As with prescription medications, patients should always read package directions before using any over-the-counter medication. Cold sore blisters can become secondarily infected with bacteria, and MedlinePlus notes that patients should always wash hands or use a clean cotton swab to apply topical medications. Because cold sore blisters reflect the active, contagious stage of the infection, it's also important to wash hands or discard the cotton swab afterward, to avoid spreading the infection to others.
Effectiveness
Cold sore blister pain treatment can provide significant relief, but patients should expect some residual discomfort. MedlinePlus recommends beginning pain treatment when the cold sore blister first appears because over-the-counter topical medications work best at this time. Patients should plan to carry medication with them as most types require re-dosing every four to six hours.
Prevention
Avoiding triggers play an important role in cold sore blister treatment. MedlinePlus recommends avoiding hot food and drinks and those that contain spices, citrus or significant amounts of sale as these can make pain worse. Drinking cool, nonacidic fluids such as ice water or apple juice, or sucking on frozen treats or ice can make pain better. Many patients are tempted to pick or play with cold sore blisters, but this causes pain and increases the risk of bacterial infections and scarring.
Considerations
Cold sore pain increases when the blister ruptures and becomes an open sore, typically after about four days, according to the Academy of General Dentistry. The sore usually lasts only one day, after which it begins to acquire a yellow brown crust that signals healing. Pain should improve significantly at this time. Pain that gets worse instead of better, that is accompanied by pus-like discharge from the cold sore, or that is accompanied by new systemic symptoms, such as fever of malaise, should be evaluated by a doctor because these are signs of secondary bacterial infections.
References
- "Harrison's Principles of Internal Medicine, 23rd Edition"; Anthony S. Fauci, M.D. et al.; 2008
- MedlinePlus: Mouth Sores
- Academy of General Dentistry: What Are Cold Sores?
- FamilyDoctor.org: Herpes
- American Dental Association: Canker Sores, Cold Sores and Common Mouth Sores
