Ways to Fight Lingering Shingles Pain

Women have the unfortunate distinction of being more susceptible than men to the painful skin disease herpes zoster, otherwise known as shingles.

Surprising: Though shingles has long been considered a once-in-a-lifetime affliction, a recent Mayo Clinic study revealed that more than 5% of sufferers experienced a second bout within the follow-up period, which averaged eight years.. and that recurrences were 60% more likely in women.

Shingles develops when the varicella-zoster virus-the same virus that causes chicken pox and then goes into hiding in nerve cells-becomes reactivated at a time when a person's immune function is reduced. Shingles risk rises with age as immunity gradually declines. The virus follows a nerve path that leads out from the spine, traveling around one side of the body and surfacing at nerve endings in the skin. The inflamed nerve becomes extremely painful and the affected skin (which reflects the location of that nerve path) erupts in clusters of fluid-filled blisters that take two to four weeks to crust over and heal.

Bad as shingles can be, an even scarier threat is a complication called postherpetic neuralgia (PHN) that develops in about 20% of shingles patients. PHN is characterized by intense nerve pain that lingers for months or years after the blisters themselves have healed. According to Salim M. Hayek, MD, PhD, chief of the division of pain medicine at University Hospitals Case Medical Center in Cleveland, the burning, stabbing sensations of PHN can be so severe that even the feeling of clothing or a breeze against the skin can be unbearable—and PHN sufferers often experience depression, isolation and concentration problems. Self-defense…

For prevention: Get vaccinated. The FDA recently lowered the approved age for receiving the shingles vaccine, Zostavax, from 60 to 50. The vaccine reduces shingles risk by an estimated 55% to 70%...and it reduces PHN risk by 67%. Vaccinated people who do develop shingles typically experience milder outbreaks and may be less vulnerable to recurrences than unvaccinated ones.

For a shingles outbreak: The first sign of shingles usually is a tingling, burning or itching sensation on the skin, most often on one side of the torso (though it can develop anywhere). This usually is followed within a few days by a red, blotchy rash that later blisters...some patients also have a headache and fever.

Important: If you have possible symptoms of shingles, see your physician immediately, Dr. Hayek advised-if taken within 72 hours of the onset of the rash, a prescription antiviral drug such as acyclovir (Zovirax), famciclovir (Famvir or valacyclovir (Valtrex) can lessen the severity of shingles and significantly reduce PHN risk.

For pain relief: If over-the-counter painkillers don't do the job, ask your doctor about taking prescription-strength ibuprofen, acetaminophen with codeine, tramadol (Ultram) or other pain medication.

For PHN: There is no cure (except, in some cases, time), but there are ways to manage the persistent pain of PHN, Dr. Hayek said. These include.

• Mindfulness-based stress reduction. A program developed at the University of Massachusetts Medical School combines yoga, meditation, support groups and individually tailored instruction to improve quality of life for PHN patients and other pain sufferers. Visit www. umassmed.edu/cm/stress for information, then check your local hospitals for similar programs.
  
• Topical medications. These inhibit damaged nerve cells in the skin from sending pain messages to the brain. The prescription skin patch Lidoderm, which contains lidocaine, is applied at home and worn for up to 12 hours per day. The prescription skin patch Qutenza, which contains capsaicin (the "hot" substance in chili peppers), is applied at the doctor's office in a one-hour procedure and replaced after three months. Nonprescription topical capsaicin products, such as the ointment Zostrix, may help-but patients should follow instructions carefully and some still may not be able to tolerate the burning sensation when capsaicin is first applied, Dr. Hayek said.
  
• Oral medications. Options include the neuropathic pain drug pregabalin (Lyrica)...the anticonvulsant gabapentin (Neurontin)...the SNRI antidepressant duloxetine (Cymbalta) a tricyclic antidepressant, such as amitriptyline (Elavil)... and opioids, such as oxycodone (Oxycontin).
  

Topical and oral PHN medications can have potentially serious side effects, Dr. Hayek cautioned—so it is important to work closely with your physician when using such drugs to manage PHN pain.

Supplements That Reduce Your Risk of Melanoma

Women with a history of nonmelanoma skin cancer who took 400 international units (IU) of vitamin D and 1,000 milligrams (mg) of calcium daily had about half the risk for melanoma as women given a placebo.

Best: Consume the recommended daily dose of vitamin D (600 IU up to age 70...800 IU if older) and calcium (1,000 mg for women up to age 50 and men up to age 70...1,200 mg if older).