By SUE NOLL
Special to The Hays Daily News
Shingles is a herpes zoster virus, a mutation of the common chickenpox. Shingles can strike anyone who's had chickenpox, at any time, without warning.
More than 90 percent of adults in the Unites States have had chickenpox, placing them at risk for shingles, and the frequency and severity of shingles increase with age. It is estimated 1 million cases of shingles are diagnosed in the United States each year, 40 percent to 50 percent of which occur in people age 60 and older.
The first signs of shingles are often felt and might not be seen. These can include itching, tingling and burning. A few days later, a rash of fluid-filled blisters appears. The blisters might take two to four weeks to heal. Sometimes the rash leaves permanent scars.
The virus that produces herpes zoster usually is suppressed with orally administered antiviral medications. Antiviral medication should be started immediately and as prescribed. Antiviral medications are most effective when started within 72 hours after the onset of the rash.
The shingles virus attacks the nervous system by attacking the nerve coatings (myelin sheath). Therefore, suppressing the virus along the affected nerve endings helps decrease the amount of destruction. Leaving the virus untreated can allow the virus to be more destructive, causing the rash and blisters to last longer. This can set the stage for skin infections to develop.
There can be potential for hearing or vision loss when the face is affected. Eye involvement is rare but serious. When the area near or in the eye is involved, referral to an ophthalmologist usually is necessary.
Another key treatment is to provide optimal pain relief during the course of the outbreak. Medications for pain might include steroids, opioids or drugs that slow down overactive nerves such as anticonvulsants, antidepressants and anesthetics. Analgesics commonly are recommended. Pain can range from mild to excruciating.
Lotions containing calamine might be used on open lesions to help reduce pain and itching. Once the lesions have crusted over, capsaicin cream (Zostrix) can be applied, but any open skin area might burn with this treatment. Anesthetic creams such as EMLA or topical Lidocaine are available.
After the rash heals, shingles might lead to pain that can last for months or years. This pain is called postherpetic neuralgia and occurs because the shingles virus has damaged certain nerves. PHN has been described as tender, burning, throbbing, stabbing and shooting or sharp pain.
As with any pain condition caused by injured nerves (neuropathic pain), often more than one treatment option is required.
When pain cannot be reduced with these methods, a referral to a pain specialist might be required. Nerve blocks, such as epidural steroid injections with an anesthetic, sympathetic nerve blockade, or implantable therapies such as spinal cord stimulators or infusion pumps, have been used to help reduce pain.
For more information, check out the American Pain Foundation's "Treatment Options: A Guide for People Living with Pain" at painfoundation.org.
If you think you might have shingles, seek medical attention immediately. If you notice possible symptoms of shingles, such as itching or tingling on your skin, call your doctor right away. Although some people go on to have residual neuropathies, many recover fully and return to being asymptomatic.
A shingles vaccine called Zostavax recently has become available to help prevent or curb the effects of shingles in the older adult population. Those 50 years and older should discuss this option with their doctors.
Learn more about shingles and what you can do by visiting the Spotlight on Shingles website, www.spotlightonshingles.com or call (877) 747-5474.
The American Pain Foundation is an independent, nonprofit organization serving people with pain through information, advocacy and support. The foundation's mission is to improve the quality of life of people with pain by raising public awareness, providing information, promoting research and advocating for the removal of barriers to effective pain management.
For more information, visit www.painfoundation.org.
Sue Noll, RN-BC, CHPN, is supervisor of Hospice & Palliative Care at Hays Medical Center. She is the Kansas leader for the American Pain Foundation Action Network.