Shingles: Managing Pain and Treatment Options

Q: Shingles: Managing Pain and Treatment Options

Hello： The pain from shingles can sometimes be extremely unbearable. <br>You can visit the outpatient clinic to describe your pain to the physician, who will adjust your medication as needed. <br>Sincerely, Dr. <br>Cheng Li-Chen, Dermatology.

Shingles

The situation is as follows: My mother underwent root canal treatment on August 26 (Saturday) for a large molar on the lower right side.
The dentist administered medication to the nerve and prescribed painkillers.
After taking the medication, my mother woke up in severe pain, so she sought treatment at another dental clinic where she received a nerve block.
However, once the anesthesia wore off, the pain returned persistently.
Eventually, my mother became afraid to take painkillers and went to see a traditional Chinese medicine practitioner.
Although acupuncture was performed, she continued to experience relentless pain.

After enduring the pain for a day (yesterday), she went to the China Medical University Hospital for an emergency consultation this morning (August 29).
The physician administered morphine for pain relief (since my mother was unsure if she had any drug allergies).
The emergency department diagnosed her with herpes zoster pain radiating to the ear, with multiple rashes on the right side of her face, and blisters on her lips (which she accidentally ruptured).
There were also blisters on her tongue.
The emergency department referred her to the otolaryngology clinic, where she was prescribed Acyclovir, Zovirax, Nincort oral gel, and Gentamicin cream.
They also prescribed Diclofenac Potassium and Mucaine tablets, as well as Imipramine.
However, my mother is still in significant pain this evening.
What can be done to alleviate her pain? I feel very distressed seeing her like this.
I happened to find this place through PTT and hope to find some help.
Thank you for reading this lengthy consultation.
I am very grateful.

Niming, 10~19 year old female. Ask Date: 2006/08/29

Dr. Zheng Lizhen reply Dermatology

Hello: The pain from shingles can sometimes be extremely unbearable.
You can visit the outpatient clinic to describe your pain to the physician, who will adjust your medication as needed.
Sincerely, Dr.
Cheng Li-Chen, Dermatology.

Reply Date: 2006/08/29

More Info

Shingles, also known as herpes zoster, is a viral infection caused by the reactivation of the varicella-zoster virus, which also causes chickenpox. It typically presents as a painful rash that develops on one side of the body, often accompanied by severe pain, itching, and discomfort. The pain associated with shingles can be debilitating and may persist even after the rash has healed, a condition known as postherpetic neuralgia (PHN).

In your mother's case, it seems that she is experiencing significant pain following dental treatment, which may have triggered the shingles outbreak. The presence of blisters on her lips and tongue, along with the rash on her face, indicates that the virus has affected the trigeminal nerve, which can lead to facial pain and discomfort.

Management of Shingles Pain
1. Antiviral Medications: The prescription of Acyclovir (Zovirax) is crucial as it helps to reduce the severity and duration of the shingles outbreak. It is most effective when started within 72 hours of the rash appearing. Ensure that your mother takes the medication as prescribed.

2. Pain Management: Since your mother is experiencing severe pain, it is important to manage this effectively. The use of opioids like morphine in the emergency department was a step in the right direction for acute pain relief. However, for ongoing pain management, consider the following options:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications like Diclofenac can help reduce inflammation and pain.

- Topical Treatments: Applying creams like Gentamycin can help with skin lesions, while oral gels like Mucaine can soothe oral sores.

- Antidepressants: Imipramine, a tricyclic antidepressant, can be effective for neuropathic pain and may help alleviate some of the discomfort associated with shingles.

3. Adjunctive Therapies:
- Acupuncture: If your mother found some relief from acupuncture, continuing this treatment may help manage pain.

- Physical Therapy: Gentle physical therapy may assist in pain management and improve mobility if she is experiencing discomfort in movement.

4. Supportive Care:
- Rest and Hydration: Ensure your mother is well-rested and hydrated, as this can aid in recovery.

- Cold Compresses: Applying cool, damp cloths to the affected areas may provide temporary relief from pain and itching.

5. Follow-Up Care: It is essential to follow up with her healthcare provider, especially if her pain persists or worsens. They may consider adjusting her pain management regimen or exploring other treatment options, such as nerve blocks or more potent pain medications.

6. Education and Emotional Support: Educating your mother about shingles and its management can help alleviate anxiety. Emotional support from family members can also be beneficial during this painful time.

Conclusion
Shingles can be a painful and distressing condition, particularly when it affects sensitive areas like the face. It is crucial to manage both the viral infection and the associated pain effectively. Encourage your mother to adhere to her prescribed treatment plan and maintain open communication with her healthcare providers to ensure she receives the best possible care. If her pain remains unmanageable, do not hesitate to seek further medical advice or consider a pain specialist who can provide more targeted interventions.

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