DEAR DR. GOTT: I am a 73-year-old female who is suffering from shingles night and day. This has gone on for about seven weeks now and I am really depressed and miserable. I was diagnosed early and was put on an anti-viral medication (Valtrex) within two days of the first pains. I have a red, blotchy band from the navel to the spine. It has gotten a lighter pink. A weird fact to anyone I’ve asked is, nobody seems to know why I have not had any blisters, just the red. The most painful spot is on my rib, right under my right breast.
I have tried several pain medications including Oxycodone, Tylenol Extra Strength, lidocaine patches which seemed to help a bit at first but irritate my skin now, ice cubes wrapped in a soft cloth, and amitriptyline. In desperation for some sleep I went to the ER at our hospital for a shot which did knock me out the better part of the day several weeks ago. A couple of weeks ago I had an epidural at a pain clinic. I can’t say it brought any amount of relief.
I have fibromyalgia (diagnosed 15 years ago), A-fib, glaucoma, colitis, and often have UTIs. I do believe I had chickenpox as a child. I can usually keep my blood pressure under control but the pain has driven it sky high. I am tired and worn out from pain.
DEAR READER: To confirm one issue, you definitely had chickenpox as a child. Once a person has chickenpox, the virus remains inactive in certain nerves of the body until (in some individuals) it reactivates years later. A repeat can occur at any age; however, a person is more likely to develop shingles if he or she is over the age of 60 or has a compromised immune system.
Initial symptoms include rash on one side of the body that is accompanied by pain and a tingling or burning sensation. These symptoms may be accompanied by fever, chills, headache, joint pain, swollen gland, muscle weakness, and more. The lesions are pink to red in color that, in most individuals, form small blisters that ultimately break, dry and crust over. I could not determine from your letter if you ever had open lesions or only the red rash that has lessened in intensity of color.
Diagnosis is frequently made through visual examination only because of the classic division of the rash on half the body. Under the best of circumstances, an anti-viral given with 72 hours of first symptoms should reduce pain and reduce the course of the disease that can last up to three weeks. When the pain lasts substantially longer – such as months or years – an individual is known to have postherpetic neuralgia that occurs when damaged nerve fibers send incorrect but mixed messages of pain from the skin to the brain that can range from mild to severe. Antihistamines taken either orally or applied to the skin, or pain medication and creams containing capsaicin may help reduce symptoms. Beyond that, corticosteroids to include prednisone may be prescribed for control; however, they are not effective for everyone.
Anyone with direct contact and open lesions can pass the virus along to people who are not immune. Should this occur, the person exposed will develop chickenpox, not shingles. Until all blisters scab over, people with shingles should avoid pregnant women, newborns and anyone with a compromised immune system. Avoid touching the lesions and try using cold compresses for pain relief.
If an individual has any weeping lesions, he or she will not be in a position to have a vaccine, yet one has been approved by the Food and Drug Administration for adults 50 and older. While it will not guarantee a person won’t get shingles, it will reduce the length, severity, and lower the risk of developing postherpetic neuralgia. Because the vaccine contains live virus, it should not be given to anyone with a compromised immune system.
You also suffer from fibromyalgia that doesn’t help reduce your pain level at all. You need to be under the care of a neurologist or a pain management specialist who can review your file and make positive recommendations for reducing what appears to be postherpetic neuralgia from your shingles. Ask about another medication than the lidocaine patch such as an anti-seizure drug or tricyclic anti-depressant which may help bring your pain under control. Good luck.
Readers who would like related information can order my Health Reports “Managing Chronic Pain” and “Fibromyalgia” by sending a self-addressed, stamped number 10 envelope and $2 (for each report) US dollars or postal money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order form from my website www.AskDrGottMD.com.
