Question: I had shingles five years ago and still have unbearable pain in my legs. No medications help very much. Do you have any suggestions?


Dr. Hibberd's Answer:

Shingles involves the reactivation of the chickenpox (varicella-zoster) virus within one of our sensory nerve bodies (called a ganglion), and extends to the skin surface causing painful blisters. Shingles rashes and pain are usually confined to a single nerve distribution pattern called a dermatome.

Immediate treatment of shingles with antiviral medication (such as Zovirax, Valtrex, or Famvir) will reduce the incidence and severity of the attack as well as decrease the incidence of the painful neuropathy sometimes encountered by patients such as yourself.

Shingles vaccination is an effective preventive measure and will decrease the severity of shingles reactivation, but must be given before the attack to be most effective.

Postherpetic neuralgia refers to the nerve pain suffered by some victims of shingles that may last from weeks to years. Treatments include antiviral drugs, initially often combined with steroid and limited pain prescription medication as a supplement, then addition of antidepressants, steroids, and nonsteroid anti-inflammatories (NSAIDs), anticonvulsants, and topical agents as needed to treat any neuropathic pain. Fortunately, most victims of shingles do not experience your degree of pain.

Long-term pain management techniques may be considered for persistent cases that may include local injection or even ablation/excision procedures performed by neurosurgery specialists. To manage your postherpetic neuralgia better, ask your doctor for consultation and referral.