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    Managing the Pain of Shingles

    Sridhar Bhaskara, MD Deaconess Comprehensive Pain Centers 02/17/2020
    Shingles is a common, painful rash that will affect up to 1 in 5 people. Identifying and treating shingles quickly can prevent further pain, and long-term complications.

    In my time as a physician, 17 years with the past 8 specializing in pain management, I’ve seen nearly 150 cases of shingles. I want to help you better understand shingles and know when to call your doctor or to seek care from the Deaconess Comprehensive Pain Center.  

    What is Shingles?
    Shingles is a painful rash that is shaped like a band or belt. It can affect people of all ages, but is most common in people over 50 and in individuals with weakened immune systems (such as from cancer treatment, diabetes, or infections that weaken the immune system).
    The medical term for the shingles virus is “herpes zoster.” It is the same virus that causes chickenpox. The first time a person is infected with the virus they get chickenpox, not shingles. After you have chickenpox, the virus can hide dormant in the body’s nerves. Years later it can inflame those nerves and show up as shingles. 
    Up to 20 % of the population will develop shingles in their lifetime, and 1 in 3 people who live to age 80 will develop shingles.
    Is Shingles contagious?
    While it is not possible to catch shingles from someone with the rash, it is possible to catch the virus, which can cause chickenpox.
    If you have not had chickenpox or the vaccine, you should avoid anyone with shingles. You could possibly get infected with the virus and develop chickenpox.

    If you have shingles, you must stay away from babies who haven’t been vaccinated for chicken pox. Chicken pox in infants can be very serious.
    If any of these apply to you, your chances of getting shingles are very low:
    • Had chickenpox or shingles in the past
    • Have had the chickenpox vaccine
    • Were born in the US before 1980 – most people born at this time have had the chickenpox
    What are the risk factors for developing Shingles?
    -           Age greater than 50
    -           Weakened immune system (such as from chemo, infection, etc.)
    -           Chronic lung or kidney disease
    -           Diabetes
    -           Transplant patients
    -           Autoimmune disease
    -           HIV infection
    -           Stress can also cause a shingles flare-up
    What are the symptoms of Shingles?
    These are the typical symptoms of shingles:
    • A “weird” sensation on the skin – possible itching, burning, pain, or tingling.
    • Some people will get fever, feel sick, or get headaches.
    • A rash with blisters will usually appear within 1-2 days. The blisters will most often band across the chest and back on one side. They can (less commonly) appear on other body parts as well, such as the hands, shoulders and occasionally face. Note: A shingles rash near the eyes is an emergency, as it can affect vision.
    • Within 3-4 days the rash can become open sores.
    • Within 7-10 days the rash should scab over – at this point most people are no longer contagious.
    • The rash will generally disappear after 3-4 weeks. Sometimes it will cause scarring and changes in the skin color.
    • Some patients can develop complications, including postherpetic neuralgia.
    How do you treat Shingles?
    Most cases of shingles can be successfully treated with antiviral medication. The three antiviral drugs we prescribe include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).
    Antiviral medication is recommended for everyone with shingles and is most effective when started within 72 hours after the shingles rash appears. If you think you have shingles, seek treatment quickly.
    We also use topical treatments that are applied directly to the skin. These treatments are intended to reduce pain and include lidocaine patches, lidocaine ointment and capsaicin cream. As appropriate, we prescribe oral pain medication.
    For a small number of people with a particularly severe case of shingles, steroid injections and/or nerve blocks may be considered for pain relief.
    If you don’t receive shingles treatment quickly, you’re at greater risk of developing postherpetic neuralgia.
    Postherpetic Neuralgia
    Postherpetic neuralgia (PHN) is the most common complication of shingles. It’s diagnosed if a patient is experiencing ongoing pain 4 months after the rash has healed. It affects 10-15% of patients, with about half of these cases in individuals over 60 years of age. The pain can continue for months or even years after the rash resolves.
    Postherpetic neuralgia can be prevented with quick treatment of shingles but if you develop the complication, there are a few treatments that can help.
    • Tricyclic antidepressants, such as amitriptyline, nortriptyline, or desipramine, to reduce the severity of pain
    • Anti-seizure medication (also referred to as “nerve stabilizers”) like gabapentin and pregabalin (Lyrica)
    • A nerve block injection
    Preventing Shingles
    The shingles vaccine is recommended for adults (some say 50 and older, some 60 or older). Whether or not you should receive this vaccine is a discussion you need to have with your primary care doctor. More details are available from the CDC.

    How to get medical treatment
    At the Deaconess Comprehensive Pain Centers, we have spots reserved on our schedules for patients with shingles. If you think you have shingles, do not hesitate to call our office. We can arrange for any needed referrals and get you in for an appointment quickly.   
    To learn more about our locations - two in/near Evansville and two in southern Illinois – or to contact us, visit
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