Because shingles often goes away on its own, many people are able to manage the pain with over-the-counter pain medications. However, it is important to see a doctor within three days so you and your doctor can decide on a treatment plan, including whether you will need antiviral medications. In people of advanced age or with a weakened immune system, a doctor should be called immediately, as shingles could pose a greater risk to their overall health.
Acetaminophen (Tylenol) or over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) can be effective in relieving mild pain. For more severe pain, prescription NSAIDs or narcotic analgesics may be necessary. In some cases, oral corticosteroids (prednisone) can be prescribed to ease the discomfort, inflammation, pain, redness, and itching associated with the rash and blisters of shingles. Common side effects of prednisone include elevation of blood pressure, increase in blood sugar, muscle weakness, and mood changes. Oral antihistamines may also help but can cause drowsiness.
Antiviral medication can also be helpful in shingles. To mitigate pain, limit the duration of symptoms, and prevent complications, antiviral medication should be started within 72 hours of the first sign of shingles. These medications, taken orally, include acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir). A typical course of treatment lasts one week. These medications are tolerated very well with almost no side effects. The antivirals can help reduce the risk of eye complications if shingles infects the face.
The varicella-zoster virus does not usually flare up more than once in adults with normally functioning immune systems. Fewer than 5 percent of people will experience a recurrence of shingles.
This section contains more information on treating complications of shingles:
The varicella-zoster virus may travel to the head and neck, perhaps involving an eye, part of the nose, cheek, and forehead. In about 40 percent of those with shingles in these areas, the virus infects the cornea. Pain, numbness, and pressure in the eye are indicators of a condition called herpes zoster ophthalmicus, and severe damage or scarring can result.
Doctors will often prescribe oral antiviral treatment to reduce the risk of the virus infecting cells deep within the tissue, which could inflame and scar the cornea. The disease may also cause decreased corneal sensitivity, meaning that foreign matter, such as eyelashes, in the eye are not felt as keenly. For many, this decreased sensitivity will be permanent.
It's important that people who have had facial shingles schedule follow-up eye examinations because corneal problems may arise months after the facial condition is gone.
Ramsay Hunt syndrome type I, also known as herpes zoster oticus, is a complication of shingles caused by the spread of the varicella-zoster virus to facial nerves. The syndrome is characterized by intense ear pain; a rash around the ear, mouth, face, neck, and scalp; and paralysis of facial nerves. Other symptoms may include hearing loss, vertigo (abnormal sensation of movement), and tinnitus (abnormal sounds). Taste loss in the tongue and dry mouth and eyes may also occur.
Some cases of Ramsay Hunt syndrome type I do not require treatment. When treatment is needed, medications such as antiviral drugs or corticosteroids may be prescribed. Vertigo may be treated with the medication diazepam.
Generally, the prognosis of Ramsay Hunt syndrome type I is good. However, in some cases, hearing loss may be permanent. Vertigo may last for days or weeks. Facial paralysis may be temporary or permanent.
Postherpetic neuralgia is a painful, chronic condition that sometimes develops following an attack of shingles. Even after the acute rash of shingles subsides, pain can persist in shingles-affected areas. With PHN, the pain persists for longer than four months after the onset of the rash. PHN occurs most often in elderly people and in patients whose immune systems have been compromised.
It's not well understood why pain persists after the shingles rash goes away, but scientists believe it may be caused by the varicella-zoster virus leaving scarring or other lesions in the cells in sensory ganglia and associated nerves.
Although postherpetic neuralgia can be extraordinarily painful, it is not life threatening. Even in severe cases, the paralysis, headaches, and pain generally subside over time. Treating shingles with antivirals at the first sign of the rash—within the first 72 hours—is believed to reduce the risk of postherpetic neuralgia and may speed up the healing process.
To treat the pain of postherpetic neuralgia, powerful narcotic pain relievers can offer relief, but, because they can have serious side effects, doctors often prescribe newer nonaddictive painkillers. Doctors may also prescribe ointments containing capsaicin, the heat-producing ingredient found in hot chili peppers, to relieve pain from postherpetic neuralgia.
A lidocaine patch allows the medication, an anesthetic, to be released into the top layers of the skin and reduces pain from the damaged nerves. Because it delivers the drug via the skin, it does not produce any significant levels of the drug in the blood and shouldn't cause serious systemic side effects.
Studies have also shown that some anticonvulsant medications used to treat epilepsy, such as carbamazepine, are sometimes effective, as are antidepressants. Some doctors report that patients occasionally benefit from alternative treatments for pain, such as acupuncture and electrical stimulation of nerve endings.
Last reviewed on 9/28/08
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