OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Paul H. Resnik, MD

The shingles virus often emerges to affect the face


Painful Shingles—There is Help

Paul H. Resnik, MD
Pain Management
Pain Clinic of Northwestern Wisconsin, Eau Claire

We have only a vague idea of what shingles is, or the amount of misery that can potentially result when an individual suffers an outbreak. Shingles is caused by the same virus that causes chickenpox, called the Varicella-Zoster virus, or VZV. Most people have chickenpox when they are children and rarely suffer severe complications. The virus runs its course as a childhood disease, and then goes into hiding, in cells that make up the nerves of the nervous system. This “hidden” stage of the virus is known as the latent phase of the virus.

At some point in about 15% of us, after the age of 50, for reasons still unknown, the VZV emerges again. It may appear as a rash, confined to a fairly well defined painful strip of skin, which follows the path of the nerve. How the virus emerges is quite variable and a rash is not always present.

Common sites of shingles

The initial outbreak of shingles is often described as an itchy, prickly, unpleasant sensation, with, or just prior to the outbreak of the rash. The most common area for shingles to appear is the chest wall. The next most often affected area is the face. Early diagnosis and treatment are essential to making the symptoms of an outbreak of shingles less severe. Unrecognized shingles can progress to nervous system complications, including blindness and/or chronic painful nerve damage that can be quite debilitating.

Medical science has made important strides in understanding this monster of a disease. Although we don’t have all the answers yet, there is hope for victims of shingles and its consequences. Early use of antiviral drugs can help decrease the duration and severity of the outbreak. It may help prevent progression to post-herpetic polyneuropathy which is defined as pain that lasts more than 4-6 weeks after an outbreak of shingles has passed. Mild pain relieving medications such as Tylenol or less potent narcotics, such as codeine, are usually helpful.

Post-herpetic polyneuropathy is thought to be due to damage to nerves by the VZV as it emerges from the nervous system after lying dormant for so many years. The suffering with long term pain caused by post-herpetic polyneuropathy, is a leading cause of suicide in the elderly.

Relief for this nerve damage pain can be challenging to find. The application of local anesthetic patches over affected areas, as well as, antiseizure-type medications in conjunction with certain antidepressant medications have been tried with some success.

Pain Medicine specialists are often called upon to help in treating patients suffering with shingles, through medications, as discussed above, or by performing a variety of special nerve blocks or injections to help relieve pain. With their pain levels decreased, people are better able to be active on their way to a full recovery from this disease.

If you suspect that you might be suffering from shingles, talk with your healthcare provider.

For more information or to schedule an appointment with Dr. Paul Resnik » 715.552.5346 or 888.235.7246, Pain Clinic of Northwestern Wisconsin