Getting shingles was bad enough. The angry, itchy, blistering rash that covered the entire right side of my torso, from naval line to spine, made me cry with pain. The weight of the bedsheets was barely tolerable.
My case of herpes zoster (HZ) was a bad one because I mistook the first symptoms for muscle pain due to the physical stress of moving residences and starting a new office job and failed to get fast treatment. That was in December 2017.
Now, almost two years later, I still suffer from postherpetic neuralgia (PHN). “Suffer” is a term I don’t use lightly because I hate to play the victim card. But, in this case, the word is appropriate. I was attacked.
Not a day goes by without nearly constant, pain that burns, aches, and sometimes stabs. These prickling feelings rove around my right side, mostly under my lowest rib, radiating downward and sideways.
I am one of the 10-15 percent of shingles patients who develop PHN, a pain syndrome that can follow an outbreak of shingles:
“PHN is typically defined as pain that endures for more than 30 days after the rash subsides, or for more than 90 days after rash onset. It can last for weeks, months or even years.”
Areas of the body affected by PHN may remain hypersensitive or may have decreased sensation after the shingles outbreak has passed. Shingles-ravaged areas may leave behind scarred skin.
Shingles affect dermatomes – areas of skin with sensory neurons that originate in a spinal nerve ganglion (cluster of nerve cells). The shingles virus lies dormant in the nerve ganglia of people who have had chickenpox.
The shingles pain, rash or both is confined to an area defined by a dermatome (a zosteriform pattern). The symptoms may not present across the entire dermatome and often stop at the body’s midline.
The prevailing medical wisdom is that there is no cure for PHN.
Prescription or over-the-counter Lidocaine patches, laced with the temporary topical pain-reliever, are small and resemble bandages that can be trimmed to cover only the affected skin. I found a 3 fluid-ounce Lidocaine roll-on product for ten dollars while shopping online.
Capsaicin skin patches, sold as Qutenza, contain a powerful concentration of a pain-killing chili pepper extract (capsaicin). This two-hour treatment is given only in a doctor’s office under professional supervision after a numbing agent has been applied to the target area. When successful, one application can reduce pain for as long as three months with the option for repeated quarterly treatments.
Some anti-seizure drugs, including gabapentin (Gralise, Horizant, Neurontin) and pregabalin (Lyrica), can ease PHN pain by stabilizing abnormal electrical activity in the nervous system caused by injured nerves. Unfortunately, the side effects (drowsiness, fogged thinking, unsteadiness, and swollen feet) make daily life difficult.
Antidepressants such as nortriptyline (Pamelor), amitriptyline, duloxetine (Cymbalta), and venlafaxine (Effexor XR), influence brain chemistry and how the mind interprets bodily pain. A doctor may prescribe a smaller dose to treat HPN. Again, the side effects (drowsiness, dry mouth, lightheadedness, and weight gain) may outweigh the benefits.
When I had shingles, other patients reported online in health forums that the only medications strong enough to combat the excruciating pain were opioids. It would stand to reason that drugs derived from the opium poppy (including heroin and morphine) would be effective in wiping away painful PHN.
But, given the current national opioid crisis, many doctors are reluctant to dispense these hard-core Schedule 1 narcotics for shingles, much less its after-effect, PHN. I myself would consider opioids as the option of last resort since they are so highly addictive and rough on the rest of the body.
Some doctors treat PHN with steroid injections into the spine but proof that this procedure works is spotty while it is known that there is a small chance of developing severe side effects, including meningitis (brain fever).
There are some home remedies I can’t wait to try – for example, capsaicin creams such as Capzasin-P (also available as a messless roll-on) and Zostrix. Both products come in various strengths. Capsaicin, the active ingredient in chili peppers that makes them hot, is added to medicinal lotions and preparations to relieve muscle or joint pain.
The heating sensation caused by capsaicin activates certain nerve cells. The burning feeling can be washed off with soap and cool water.
Used regularly, capsaicin topicals can reduce the amount of substance P in the body, a chemical pain messenger.
NOTE: Do not use any capsaicin product if you have a chili pepper allergy.
Other home treatments include:
TENS (transcutaneous electrical nerve stimulation), a portable electronic device that sends tiny shocks to pairs of electrodes that stick to the skin. I love my TENS unit but it isn’t highly recommended for the chest and abdominal areas. This mini-shock therapy is great for relaxing muscles in the lower back, sciatic, deltoid, upper arm, elbow, hip & thigh, knee, calf, ankle, and foot.
Cold packs may numb areas left painful by PHN. The gel-filled kind is preferred. Discontinue use if symptoms worsen.
Loose-fitting clothes made from soft fabrics such as cotton and silk can help ease PHN discomfort, as I can attest.
An ounce of prevention is worth a pound of cure, they say, and insurance will often cover 100 percent of the pricey shingles vaccine Zostavax for patients aged 60 and older. This is one of the few vaccines I recommend, having gotten mine after the fact to prevent the unlikelihood of a second outbreak.
Stay tuned for my capsaicin product reviews. Fingers crossed for leaving my PHN behind!