Q: My mother has had pain from shingles since 1984. She has suffered with them terribly and is always looking for something that might help the pain. She found this one ointment that has helped with the pain some. Can you help us?
A: Shingles, or herpes zoster, is a viral infection of the nerves. It is a reactivation of the chicken pox virus, varicella. So only those who have had chicken pox get shingles.
Shingles is relatively common; over 1 million North Americans have it at any one time. It is seen more often in older adults.
The symptoms begin with pain and itching in the skin along infected nerve pathways, usually on the trunk or face.
Shingles typically lasts from two to six weeks. However, the virus never leaves the body, so it may be reactivated, even years later. Shingles returns in about one in 25 people.
The reason that the virus reactivates is unknown. But the virus can be reactivated when the immune system is impaired by certain drugs or by diseases, such as with AIDS or lymphomas.
Antiviral drugs, such as famciclovir or valacyclovir, taken orally for seven days in a row are helpful in treating shingles. But they do not eliminate the shingles virus completely from the body.
Topical drugs such as antiviral medications help some people. A recent study found that peppermint oil applied directly to the lesions helps reduce itching and pain for a few hours. Ointments that contain capsaicin also help some people.
Aspirin and codeine can help control the pain. Regional nerve blocks, with or without steroids, or tricyclic drugs and phenothiazines, can help control pain if analgesics are ineffective.
A frequent complication of shingles is a condition known as postherpetic neuralgia. Approximately 20 percent of people with shingles will get PHN. Their pain will last more than a month after the eruptions of shingles are seen.
This disorder is often more painful and more long-term than shingles, sometimes lasting for a year or more. It is characterized by chronic, burning pain that continues in the areas supplied by the nerves that were affected by the shingles.
The pain is very severe for some people. The pain can be constant or intermittent. The pain can result in fatigue, sleep disturbance, anorexia and depression.
No treatment for postherpetic neuralgia has been found to be uniformly effective. Traditional pain relievers offer little benefit for the treatment of PHN.
However, once the postherpetic neuralgia has been established, the pain can be relieved with capsaicin ointment, tricyclic antidepressants or opiate based drugs such as morphine or methadone.
The FDA has recently approved a patch containing a 5 percent solution of a local anesthetic used by dentists (lidocaine) that also controls the pain. The lidocaine patch has been found to be effective, simple to use and without systemic side effects.
Percocet is a potent analgesic for the relief of moderate to moderately severe pain. But the main ingredient of Percocet is a narcotic called oxycodone so it can produce drug dependence.
Recently the drug gabapentin (Neurontin) has been shown to be an effective when added to other forms of treatment.
Since your mother has had her pain for so long, I suggest that she see another doctor, perhaps a neurologist, to discuss the treatment options open to her.
Update on B vitamins: There's increasing evidence that a diet rich in B vitamins, especially folic acid, reduces atherosclerosis and blood vessels diseases of the heart and brain.
Some recent studies have shown that combinations of vitamins B-6 and B-12 with folic acid will reduce the risk of reblockage in people who have had their heart arteries opened with a catheter (angioplasty).
Since B vitamins are safe and inexpensive, it makes sense to supplement your diet with them, especially to help prevent blood vessel diseases and be part of the treatment for anyone who has one of these diseases.
Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, Ill., 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.