Pain management: Shingles

Shingles is an infection caused by the same virus that causes chickenpox, the varicella-zoster virus. Shingles results in a rash that can be mildly itchy to intensely painful. The rash appears as raised dots that develop into blisters, then dry out and crust over.

Who gets shingles?

Shingles occurs in people who had chickenpox previously; in cases of shingles, the dormant (inactive) varicella-zoster virus becomes active again.

Shingles generally affects the elderly, but it can appear in younger people or in people who are immunodeficient (lacking the proper immune defences to fight off illness).

What are the symptoms of shingles?

The first sign of shingles usually is a tingling feeling, itchiness, or stabbing pain on the skin. A rash appears, after a few days, as a band or patch of raised dots on the side of the body or face. The rash develops into small, fluid-filled blisters that begin to dry out and crust over within several days. When the rash is at its peak, symptoms can range from mild itching to extreme and intense pain.

How is shingles diagnosed?

A doctor can normally diagnose shingles by the symptoms and physical examination alone.�Further testing is not normally necessary but the doctor may use laboratory tests to determine the presence of the varicella-zoster virus in some cases.

How is shingles treated?

Anticonvulsants, and topical agents. Sometimes additional medicines, like ibuprofen, may be needed to help control the pain.

The severity and duration of an attack of shingles can be significantly reduced by immediate treatment, and no later than 72 hours, with the antiviral drugs aciclovir, famciclovir or valaciclovir. These drugs may also help stave off the painful after-effects of shingles, a condition known as postherpetic neuralgia.

Is shingles contagious?

Contact with a person who has shingles may cause another person to develop chickenpox (but not shingles) if the exposed person has never had chickenpox.