A major concern for patients with shingles is the development of a complication called postherpetic neuralgia, which, at times, can be very debilitating.
Shingles, or herpes zoster infection, is not uncommon, especially as one gets older. Symptoms vary from being mild to severe. However, a major concern for patients with shingles is the development of a complication called postherpetic neuralgia, which, at times, can be very debilitating.
A recent article reviewed this condition. The most common symptom is pain due to the nerve damage that occurs during the acute phase of shingles. For the diagnosis to be made, this pain must persist for at least 90 days after the onset of the shingles rash.
The incidence of postherpetic neuralgia increases with age. At age 50 to 54, 8 percent of the patients will develop neuralgia. This increases to 20 percent at age 80 to 84.
The pain can last a long time. Fifteen percent of patients still have pain after two years. The pain varies in its presentation. It can be a continuous burning sensation, a shooting pain and a pain that occurs after light contact to the involved area.
Unfortunately, treatment is frequently not very effective. Less than half of the patients have a 50 percent or more reduction in pain with the present modes of treatment. Applying certain creams to the skin lesions is occasionally helpful. Neurontin medication has been successful in some patients. Narcotics, such as morphine, are considered to be last resort medications and are not always successful, and their use is controversial.
At one time it was thought that shingles and postherpetic neuralgia did not recur but recent studies indicate that the recurrence risk can be as high as 6 percent.
The best way to prevent postherpetic neuralgia is to prevent shingles from taking place. This can usually be accomplished by the use of a herpes zoster vaccine. Studies have shown that the vaccine reduces the incidence of herpes zoster by 50 percent and postherpetic neuralgia by 66 percent. It is not as effective in the older age group.
So although strides have been made in the treatment of postherpetic neuralgia, much more needs to be done. Fortunately, research to find more effective treatment is underway and promising new drugs are now being evaluated.
Massachusetts-based Dr. Murray Feingold is the physician in chief of The Feingold Center for Children, medical editor of WBZ-TV and WBZ radio, and president of the Genesis Fund. The Genesis Fund is a nonprofit organization that funds the care of children born with birth defects, mental retardation and genetic diseases.