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If you suddenly develop severe pain in a limited area on one side of your body, you may have shingles and need treatment immediately to prevent that pain from lasting for the rest of your life. It's called postherpetic neuralgia, a complication of shingles. If you have severe pain that is not caused by an injury and your doctor cannot find a cause, you should get a blood test for herpes zoster and start taking Famvir or Valtrex immediately to prevent the pain from becoming permanent.

The first time you get chicken pox, blisters form over most of your body. After a week, your immunity drives the chicken pox virus from your bloodstream, but it remains in your nerve roots for the rest of your life. One of every in six people who get chicken pox will have the virus escape from nerves many years later to cause painful grouped blisters on the skin over the infected nerve on one side of the body (11).

If you wait for characteristic blisters to form, it may be too late to prevent the pain from lasting the rest of your life. 50 percent of people over 60 who develop shingles, and are not treated, will suffer from post-herpetic neuralgia and have severe pain in that nerve for the rest of their lives, while fewer than 7 percent treated with acyclovir will suffer permanent pain (7). Cortisones offer little protection (8). If you develop postherpetic neuralgia, your pain can be treated with a .025% capsaicin cream (9) and tegretol or gabapentin anticonvulsant pills (10). One study reported a more effective treatment: 60 mg of methyl prednisone, injected directly into the spinal fluid, once a week for four weeks, lessens and even cures the pain (12).

In May 2006, The US Food and Drug Administration approved a vaccine to prevent shingles, called Zostavax, for adults over 60. At this time we have no good data on its use in younger adults, and it is not clear how long immunity lasts. I recommend it highly because it can prevent this common cause of pain that can become lifelong. Zostavax should not be given to people with weakened immune systems, such as with AIDS, cancer therapy, diabetes and so forth.

1) RH Dworkin, RJ Boon, DRG Griffin, D Phung. Postherpetic neuralgia: Impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. Journal of Infectious Diseases 178: Suppl. 1(NOV 1998):S76-S80.

2) MJ Wood, S Shukla, AP Fiddian, RJ Crooks. Treatment of acute herpes zoster: Effect of early (<48 h) versus late (48-72 h) therapy with acyclovir and valaciclovir on prolonged pain. Journal of Infectious Diseases 178: Suppl. 1(NOV 1998):S81-S84. 3) CPN Watson. Postherpetic neuralgia: The importance of preventing this intractable end-stage disorder. Journal of Infectious Diseases 178: Suppl. 1(NOV 1998):S91-S94. 4) MJ Wood, R Kay, RH Dworkin, SJ Soong, RJ Whitley. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: A meta-analysis of placebo-controlled trials. Clinical Infectious Diseases 22: 2 (FEB 1996):341-347. 5) JL Jackson, R Gibbons, G Meyer, L Inouye. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: A meta-analysis. Archives of Internal Medicine 157: 8 (APR 28 1997):909-912. 6) KS Erlich. Management of herpes simplex and varicella-zoster virus infections. Western Journal of Medicine 166: 3 (MAR 1997):211-215. 7) NEJM March 31, 1994;339(13):896-900. 8) RJ Whitley, H Weiss, JW Gnann, S Tyring, GJ Mertz, PG Pappas, CJ Schleupner, F Hayden, J Wolf, SJ Soong, C Laughlin, J Gnann, L Sherrill, P Pappas, S Greenberg, J Peacock, J Tilles, F Flowers, K Beutner. Acyclovir with and without prednisone for the treatment of herpes zoster - A randomized, placebo-controlled trial. Annals of Internal Medicine 125: 5 (SEP 1 1996):376-383. 8) Archives of Internal Medicine 1997(June);157:1217-1224. 9) WY Zhang, ALW P. The effectiveness of topically applied capsaicin - A meta-analysis. European Journal of Clinical Pharmacology 46: 6 (JUL 1994):517-522. 10) M Rowbotham, N Harden, B Stacey, P Bernstein, L Magnusmiller. Gabapentin for the treatment of postherpetic neuralgia: A randomized controlled trial. JAMA, Journal of the American Medical Association. 280: 21 (DEC 2 1998):1837-1842. 11) JG Donahue, PW Choo, JE Manson, R Platt. The incidence of herpes zoster. Archives of Internal Medicine 155: 15 (AUG 7 1995):1605-1609. 12) NEJM, November 23, 2000 Checked 1/24/15

May 30th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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