Shingles: Pain Management, Prevention, and Treatment Options

Q: Shingles: Pain Management, Prevention, and Treatment Options

Hello： I would like to ask on behalf of my family. <br>If someone has pain in certain areas, and they proactively inform the doctor that there has been a history of shingles in the household, will the doctor provide vaccination or other treatments, or will treatment for shingles

Shingles, also known as herpes zoster, is contagious for up to 72 hours. It is associated with the varicella-zoster virus, which is also responsible for chickenpox?

Last year, I had shingles and have been experiencing pain since then, so I returned for a follow-up.
This year, I developed two new lesions.
Recently, another family member also contracted shingles.
Although I am somewhat aware of the typical progression, at first, he thought his pain was due to a bone issue and consulted an orthopedic doctor several times.
It was only after the blisters appeared that he realized it was shingles.
The second family member is aware of the "golden 72 hours" for treatment, but neither he nor the doctor recognized it as shingles, resulting in unnecessary orthopedic injections.
I would like to ask on behalf of other family members: if someone experiences pain in certain areas, should they proactively inform the doctor about a family history of shingles? Will the doctor consider administering the vaccine or other treatments, or will they wait until the blisters appear to begin shingles treatment?
(1) If a shingles patient’s blisters have dried and do not contain fluid, can we be assured that it is no longer contagious?
(2) If the skin has healed but new lesions appear the following year, how can we prevent transmission to others?
(3) Why do I experience headaches or stomachaches after taking a B-complex vitamin that is advertised?
(4) I found information online suggesting that B vitamins can help with headaches, but it seems to affect me differently.
If a shingles patient cannot take B vitamins for health benefits, what other vitamins can they take?
(5) Thank you.

Niming, 60~69 year old female. Ask Date: 2019/03/21

Dr. Jiang Junyi reply Neurology

Hello: I would like to ask on behalf of my family.
If someone has pain in certain areas, and they proactively inform the doctor that there has been a history of shingles in the household, will the doctor provide vaccination or other treatments, or will treatment for shingles only begin once the blisters appear? (1) A: Typically, antiviral medications for herpes will be prescribed only when blisters appear, as this is when shingles is considered.
These medications may have side effects such as nausea, diarrhea, and headaches.
If the blisters of the shingles patient have dried up and are no longer oozing, can we assume there is no risk of transmission? (2) A: Generally, during the blistering phase, the blisters contain the virus.
Once the blisters crust over, they no longer carry the virus.
However, if the skin heals and then outbreaks recur the following year, how can we prevent transmission to others? (3) A: Recurrent infections may indicate a relative deficiency in immunity, and antiviral medications may be considered.
Regarding the B vitamins that are advertised, why does taking just one cause headaches or stomach pain? (4) A: I'm not sure which specific type you are taking.
Based on experience, taking B vitamins after meals usually results in fewer instances of stomach pain.
The current shingles vaccine is a live attenuated vaccine, which cannot be administered to individuals with significantly compromised immunity; additionally, the protective effect decreases with age, providing about 50% protection for those over 60 and only about 40% for those over 70.
I recommend consulting a neurologist for further evaluation and treatment.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2019/03/21

More Info

Shingles, also known as herpes zoster, is a painful rash caused by the reactivation of the varicella-zoster virus, which also causes chickenpox. Understanding shingles is crucial for effective pain management, prevention, and treatment options, especially for those who have experienced it or have family members who have.

Pain Management
Pain associated with shingles can be severe and debilitating. It often presents as a burning or stabbing sensation, typically localized to one side of the body where the rash appears. For pain management, healthcare providers may recommend several approaches:
1. Medications: Antiviral medications such as acyclovir, valacyclovir, or famciclovir can help reduce the severity and duration of shingles if taken within 72 hours of the rash's onset. Pain relief can also be achieved through over-the-counter analgesics like acetaminophen or NSAIDs (e.g., ibuprofen). In more severe cases, prescription medications such as gabapentin or pregabalin may be used to manage neuropathic pain.

2. Topical Treatments: Calamine lotion or lidocaine patches can provide localized relief from pain and itching. Capsaicin cream may also help reduce pain over time.

3. Nerve Blocks: In some cases, a healthcare provider may recommend nerve blocks for more severe pain that does not respond to other treatments.

Prevention
Preventing shingles is primarily about vaccination. The shingles vaccine (Shingrix) is recommended for adults over 50, regardless of whether they have had shingles before. This vaccine significantly reduces the risk of developing shingles and its associated complications, including postherpetic neuralgia, a condition characterized by persistent pain even after the rash has healed.

Treatment Options
If someone suspects they have shingles, it is essential to seek medical attention promptly. Early intervention can lead to better outcomes. If a family member has had shingles, it is wise to inform healthcare providers about this history, as it may prompt them to consider vaccination or preventive measures for other family members, especially those at higher risk.

1. Vaccination: If a family member has had shingles, others in the household should discuss vaccination options with their healthcare provider, particularly if they are over 50 or have weakened immune systems.

2. Hygiene Practices: While shingles is not contagious in the same way as chickenpox, the virus can be spread to individuals who have never had chickenpox or the vaccine. It is crucial to avoid direct contact with the rash until it has completely crusted over.

Addressing Specific Concerns
1. Transmission: Once the shingles blisters have dried and crusted over, the risk of transmission is significantly reduced. However, it is still advisable to maintain good hygiene and avoid close contact with vulnerable individuals until the rash has fully healed.

2. Recurring Shingles: Some individuals may experience shingles more than once. While the exact reason for recurrence is not fully understood, factors such as stress, weakened immune systems, or certain medications can contribute. Maintaining a healthy lifestyle, managing stress, and getting vaccinated can help reduce the risk of recurrence.

3. B Vitamins and Side Effects: If taking B vitamins causes headaches or gastrointestinal discomfort, it may be due to individual sensitivity or dosage. It is essential to consult with a healthcare provider to determine the appropriate type and dosage of vitamins. Other vitamins, such as vitamin D or magnesium, may also support nerve health and overall well-being.

4. Alternative Supplements: If B vitamins are not tolerated, consider discussing other supplements with a healthcare provider. Omega-3 fatty acids, magnesium, and certain herbal supplements may provide benefits without the side effects experienced with B vitamins.

In conclusion, understanding shingles involves recognizing the importance of early treatment, effective pain management, and preventive measures. If you or a family member experiences symptoms consistent with shingles, it is crucial to seek medical advice promptly to ensure appropriate care and support.

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