Sunday, February 26, 2012

Shingles

For those who have had the disease, the term, "shingles" may evoke dread, pain and misery.  For those who have not, it may stir confusion and fear.  The name "shingles" comes from the Latin word "cingulum," which means belt or girdle.  Shingles is the reactivation of the chicken pox virus (herpes zoster) that lays dormant in our nerve roots.  We never completely get rid of it.  Later in life, the virus may escape the surveillance of our immune system, which keeps it in check, and will flare through one of the nerves.  These nerves commonly wrap around from the spine to the front of the body in a belt like fashion, thus the term "cingulum."  The rash irritates the corresponding nerve, resulting in pain which can be quite severe.  As opposed to muscle or joint pain, shingles pain does not respond well to the usual pain killers.


Sometimes the pain is the first symptom that presents itself.  At this stage it can be difficult to diagnose.  I have been fooled more than once by shingles, but if I am at all suspicious, I'll warn my patients that if a rash develops, to let me know. Recently I have been seeing a woman for back pain going down her leg.  It sounded very much like sciatic nerve pain.  We discussed using heat and she then told me that she had tried that but it gave her a rash.  I asked her to show me the rash and there it was: shingles.  It did not occur to her that it was related but her lack of response to the usual treatments for back pain made absolute sense when I realized the correct diagnosis.


Whereas chicken pox is a viral illness that goes throughout the body, shingles is confined to just the nerve root.  Chicken pox is highly contagious as it is spread through tiny droplets of moisture that is released in the atmosphere by simple breathing.  Shingles is only contagious to those who have never been exposed to the chicken pox virus or vaccine and only if there is direct contact to the rash.  If it is transmitted, the receiver will get chicken pox, not shingles.  You cannot give someone else shingles directly.


If shingles is diagnosed within three to four days of developing the rash, antiviral medications can be given which will shorten the duration of symptoms and decrease the chance of developing the painful nerve syndrome (post herpetic neuralgia).  If you think you have shingles, go see your doctor.  The rash may start as a few blisters on a red base (similar to chicken pox).  There is often a feeling of burning over the skin.  Many confuse this with a patch of insect bites.  


In addition to the antiviral medication, the pain can be treated with medicine that calms down nerve transmissions (such as gabapentin).  If the rash is in a defined area, topical lidocaine (lidoderm) can also be effective.  

It is now recommended that patients in their 60's receive the shingles vaccine (Zostavax).  It is quite safe, being the same vaccine used with children for the chicken pox virus, only it is given at a higher dose.  It decreases the chance of getting shingles by about 75%.  My patient with the back pain actually had been vaccinated, so it is not 100% foolproof.  The biggest issue with the vaccine is its cost.  Most facilities charge $250 for the shot and as of now, insurance coverage is spotty.  Check with your carrier first if you are considering getting the vaccine.

1 comment:

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