RN Care Manager Jenice Francis administers the shingles vaccine to U.S. Army Veteran Ivan Velazquez.

Pain Management

Reducing the Pain of Shingles

Recent studies show the efforts made to raise awareness and increase vaccinations for the Varicella Roster Virus that causes Chickenpox and Shingles have been effective in reducing the number of incidents in Veterans. According to principal investigator and co-author of the landmark 2004 Shingles Prevention Study, Dr. John Toney, Director of Healthcare Epidemiology, Antimicrobial Stewardship, and Infectious Disease Clinical Research Programs at the James A. Haley Veterans' Hospital and Clinics in Tampa, Fla., and Professor of Medicine in the Division of Infectious Disease and International Medicine at the University of South Florida Morsani College of Medicine. 

In the largest study ever to investigate the disease, more than 38,500 older adults were enrolled in the study, 1,200 Veterans and others at the Tampa VA Hospital alone, data that resulted introduced the first ever shingles vaccine approved in 2006 by the Federal Drug Administration for people older than 60.

Dr. Toney explained that antiviral medication shortens the timeframe of the rash, reduces pain during the illness’s active stage, and reduces the chance of getting complications of shingles, known as postherpetic neuralgia or PHN. "For most people, the rash comes and goes within two to four weeks", he said, “If you catch it early and are seen and treated within 72 hours of the rash first appearing, you’ll have the best outcome. Your doctor will likely put you on antiviral medication”.

Risk Factors include anyone who’s had chickenpox or been exposed to someone who has chickenpox. And the risk increases with age. About half of all shingles cases occur in people older than 60. Additional risk factors include having a disease or illness that weakens your immune system, like HIV/AIDs, Cancer, (especially Hodgkin disease or lymphoma), and patients currently taking medications that suppress their immune system, including steroids.

"The Real Danger is Postherpetic Neuralgia (PHN), the serious, persistent nerve condition that continues long after the shingles blisters have healed. It can last weeks, months, even years after the virus is no longer active." - Dr. John Toney

The rash and the pain of shingles aren’t the real problem, according to Dr. Toney, who said those will go away.  The real danger he explained, is PHN, the serious, persistent nerve condition that continues long after the shingles blisters have healed. It can last weeks, months, even years after the virus is no longer active.

Complications can include vision loss, neurological problems, skin infections, permanent scarring and a debilitating type of pain that is beyond description.

Most people will have one episode of shingles, another 20 percent will get it again, and it’s rare to have it a third time, according to Dr. Toney. “But one in every five people who get shingles will get the most painful kind--and you have no way of knowing who will get it,” he said.

Patients should be advised to avoid scratching or touching the rash, keep it covered and wash their hands often to prevent infecting others. The virus that causes shingles can be spread from a person with shingles when blisters are present to another person who has never had chickenpox or chickenpox vaccine. After the rash has developed a crust like appearance in a person with shingles, the person is no longer contagious.

"If you’ve had chickenpox and are age 60 or older, get vaccinated", says Dr. Toney. He also cautioned that not everyone is a candidate for the shingles vaccine. “If you’re on medications that suppress your immune system, you should wait. And if you have HIV disease or other conditions that affect your immune system, you shouldn’t get it,” he said, "Discussion with your primary care provider is the best course of action".

Source: va.gov

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