The Lesser-Knowns of Shingles

Shingles is a viral infection caused by the reactivation of the varicella-zoster virus. When a person is first infected with this virus, they get chickenpox. In other words, shingles occur when the varicella-zoster virus begins attacking the spine again, usually due to a weakening immune system or aging. Most cases of shingles occur as isolated rashes – painful but limited to the skin. Symptoms include:

• • Blisters
  • Intense itching
  • Uncomfortable skin sensations (numbing, burning, prickling, and tingling)

Sometimes, shingles can lead to significant and developing nerve pain, even long after its other symptoms have ended. This nerve pain can be so substantial that even a light breeze can feel excruciating. Symptom severity differs from person to person, based on factors like genetics and age. Many report mild symptoms, while others might fall very ill and experience severe fevers and gastric symptoms.

How Does Shingles Develop?

The varicella-zoster virus causes chickenpox upon first contact, a disease that is usually seen in children. This disease is incredibly contagious for anyone who has not had chickenpox before, as for those who have been naturally immunized. The virus spreads through direct contact with the resulting rash, as well as coughs, sneezes, and air droplets from speech.

Once the virus infects the human body, it attacks dorsal root ganglions, clusters of sensory neurons that are part of various spinal nerves, interacting between the central and peripheral nervous systems. Symptoms develop on patches of skin (dermatomes) associated with the inflamed neurons. Therefore, the body begins to develop rashes, painful itchiness, and fluid-filled blisters, although the actual point of attack is the spinal cord. Symptoms include:

• • A rash isolated to one or more “dermatomes” or patches of skin affected by a single spinal nerve.
  • So-called “satellite lesions” may occur around the dermatome.
  • Tingling, burning, and other uncomfortable sensations.
  • Mild to a severe increase in pain sensitivity in one or more parts of the skin.
  • Various symptoms related to where the virus attacks, including loss of taste and ear pain from an infection in the facial nerve, damage to the eye due to ophthalmic nerve inflammation, etc.

Once the initial infection passes, the person who overcame it will be at risk for a second inflammatory episode called shingles. Shingles are still contagious, but not to those who have already been vaccinated or survived chickenpox. Being infected by someone with shingles would still give you chickenpox first. Thus, shingles are not directly transmittable (it can only cause chickenpox).

A lowered immune system heightens the risk of developing shingles, as does age. The CDC recommends that adults aged 50 and above can reduce their risk of developing shingles by being further inoculated, even despite their natural immunity, via the Shingrix vaccine. People who are at a naturally higher risk to suffer complications from an infection with the varicella-zoster virus include:

• • Immunocompromised people
  • People over the age of 50
  • Infants under 12 months old
  • Pregnant women
  • Anyone who has not had chickenpox, or vaccination for chickenpox

Shingles vs. Chickenpox

While the difference between the two seems semantic mainly, there are other differences between chickenpox and shingles. The most significant is that shingles more commonly causes a condition called postherpetic neuralgia, which is characterized by severe nerve pain (and associated pain symptoms) as the nerves damaged by the virus continue to send false signals to the brain, despite other symptoms (such as the rash and fever) having come and gone.

Another difference is that it is possible to suffer shingles multiple times. The virus never truly goes away – injection can help the body fend off a reactivation. Still, once you get chickenpox, the risk of shingles is ever-present, even after previous shingles episodes. Vaccines can significantly reduce that risk, and it seems that individual lifestyle choices that boost the immune system also tend to help reduce the risk of a recurring activation.

Shingles and Nerve Pain

The chances of developing recurring shingles are relatively low for the general population, but the risk is higher for older patients. One of the common complications caused by shingles in later life is the development of postherpetic neuralgia, recurring or constant pain in the same area the virus attacked previously, lasting months, years, or even permanently after the rash has passed.

It is currently estimated that roughly 20 percent of people who experience shingles will develop postherpetic neuralgia, and the risk increases with age. Symptoms of postherpetic neuralgia include:

• • Pain that persists after the rash has gone
  • Extreme pain sensitivity (pain at a light touch, a breeze, clothing, etc.)
  • Extreme temperature sensitivity
  • Numbness or tingling
  • Muscle weakness
  • Partial paralysis
  • Extreme fatigue
  • Trouble sleeping

How Postherpetic Neuralgia Is Treated

Treatments for postherpetic neuralgia vary and center around addressing the pain. Prevention is an integral part of the process. The varicella-zoster virus vaccine does not just help inoculate individuals against chickenpox and shingles but can also help reduce the severity of shingles and its potential complications (including postherpetic neuralgia). Treatments for postherpetic neuralgia are mostly non-invasive and include:

• • Electrical nerve stimulation (transcutaneous and spinal cord)
  • Opioid medication (oral medication, skin patches, ointments)
  • Capsaicin patches
  • Anticonvulsants
  • Nerve blocks (corticosteroid, Botox, or anesthetic injection)
  • Antidepressant medication (cyclic antidepressants, to reduce pain sensitivity)
  • Alternative treatments (home remedies, acupuncture, herbal medicine)

Postherpetic neuralgia can cause other problems in life, including low appetite and trouble sleeping. Some patients may benefit from investing in sleeping aids and comfortable clothing and bedwear that does not chafe or irritate the skin. Consider materials like silk and pure cotton. Cool packs, cold patches, or heating ointments containing camphor or capsaicin may be helpful as home remedies for reducing the pain.

However, it would be best to consult your doctor for better, individualized suggestions and methods. About one in three people in the US will get shingles at some point during their lives. It is a good idea to ask your doctor about a shingles vaccination if you are not immunocompromised and older than 50 – even if you have already had shingles or got chickenpox as a child.