Shingles Treatment Options, New and Old
Nearly one in three people in the United States will experience shingles, or herpes zoster, during their lifetime. If this painful disease strikes you, do you know what shingles treatment options are available? Here’s a look at shingles and what’s new and old in the realm of treatments.
What is shingles?
An estimated 1 million people in the United States develop an infection of the nerves, typically those in the abdomen, face, and chest, caused by the reactivation of the virus that causes chickenpox. This virus, the herpes varicella-zoster virus, lies dormant in individuals who had chickenpox when they were younger, but then the virus can become active in later years, resulting in shingles.
About 1 to 5 days before shingles becomes apparent, people usually feel pain, tingling, or itching in the face, abdomen, or chest. Then a rash appears on one side of the body or face and goes on to form blisters that usually scab over in about 10 days. For most people with shingles, the condition then clears up in 2 to 4 weeks.
In about 20 percent of patients, however, a complication called postherpetic neuralgia (PHN) develops. PHN is characterized by persistent, often severe pain that continues for months, even years, after shingles has resolved.
New treatment for postherpetic neuralgia
At a recent American Academy of Pain Medicine meeting, researchers announced the results of a study showing how gabapentin was effective in treating PHN. More than half of the 197 men and women (average age, 67 years) treated with gabapentin once daily for eight weeks reported their pain was “very much improved” or “much improved.” The patients in the study had experienced PHN for an average of 29 months.
Gabapentin also was associated with improvements in sleep, ability to walk, mood, and quality of life. Nearly 19 percent of the patients experienced some side effects of the drug, including dizziness (13.7%), sleepiness (5.6%), headache (3.6%), and nausea (3.6%). Researchers are planning more investigation into the use of gabapentin for PHN.
More treatment options for shingles and PHN
If you suspect you are developing shingles, contact your doctor as soon as possible. Why? Because the antiviral medications used to treat shingles are effective if they are started as soon as possible after the rash appears.
The antiviral drugs used to treat shingles are acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), and they can help reduce the severity and duration of the disease. These medications usually need to be taken 2 to 5 times a day, and they are associated with side effects such as headache, dizziness, nausea, and vomiting.
Over-the-counter pain medications such as ibuprofen, acetaminophen, and aspirin can be helpful for reducing pain. A topical treatment called capsaicin cream can be beneficial for both shingles and PHN.
Capsaicin is the active ingredient in hot peppers, and when it is part of a lotion or ointment, it can help reduce nerve pain. Products containing capsaicin are available both OTC and by prescription.
Other treatment options for PHN include the following:
- Antidepressants, which have an impact on neurotransmitters (e.g., norepinephrine, serotonin) that are involved in pain interpretation
- Skin patches containing lidocaine, a local anesthetic that can relieve burning, itching, and pain
- Anticonvulsants, which may suppress abnormal electrical activity in the nervous system
- Prescription pain killers, such as oxycodone and tramadol
- Transcutaneous electrical nerve stimulation (TENS), which treats the painful areas with mild electrical impulses via patches placed on the skin. TENS can be done at home using a small portable unit
- Peripheral nerve stimulation, which is similar to TENS except devices are implanted under the skin.
You can also reduce your risk of developing shingles by getting the shingles vaccine, Zostavax. The Advisory Committee on Immunization Practices recommends the vaccine for people age 60 and older, but the vaccine is not a guarantee you will not develop shingles.
In fact, clinical trial results showed that Zostavax reduced the risk of developing shingles by 51 percent and the risk of PHN by 67 percent. The vaccine is believed to be effective for at least six years, according to the Centers for Disease Control and Prevention.
Shingles and postherpetic neuralgia are conditions that will affect a significant segment of the adult population. Therefore it pays to know what your treatment options are ahead of the game.
Centers for Disease Control and Prevention
Dunteman E et al. Safety and efficacy of gastroretentive gabapentin in real-world clinical practice for treatment of patients with postherpetic neuralgia. AAPM 2013; abstract 121