Approximately 90% of adults are at risk for shingles

“It was the worst pain I have ever experienced. I have never taken time off work before, even when I felt unwell, but this time I couldn’t go to work. It was so painful to touch that I couldn’t even put my clothes on. I even tried to put my back into the freezer to see if it would help! But it didn’t – nothing helped. It was like a deep-seated torture.

Once the rash started the pain became a lot worse, but then my doctor was able to tell me that I had shingles and I could start treatment. I would not want to go through that again.”

Devastating impact

Leanne is a 50 year old executive. Her experience is typical for someone her age who is unlucky enough to experience this illness.

“Patients describe the pain of shingles in different ways, often as severe and excruciating. Typically it is described as a burning sensation, says Dr Jody Pearl, a neurologist in private practice in Johannesburg. “Once the pain starts, the impact on your life can be devastating.”

Read: Nerve pain

Dr Allison Glass, a specialist virologist at Lancet laboratories says: “The pain caused by shingles can remain with one for years. When this happens, it significantly impacts on your health and quality of life”.

Anyone can get shingles

Almost all adults – approximately 9 out of 10 – are at risk of getting shingles!

These odds seem incredibly high. How can this be?

Almost everybody has, at some time in their life, been exposed to the varicella zoster virus, the same virus which is responsible for both chickenpox and shingles. Chickenpox is a common childhood illness, and after you’ve had this infection, the virus remains in the body, lying dormant in the root of the sensory nerves that supply the skin. From there, and at any time, the virus can be re-activated and travel back down the nerve to the skin, causing the rash and, in some cases, the severe pain that is characteristic of shingles.

“Anyone who has had chickenpox is at risk of getting shingles”, says Dr Glass. “However, because in children, exposure to the chickenpox virus can have very mild symptoms, you might not even remember having ever had chickenpox. The immune system can suppress and keep the virus under control for many years, but, with time and as one gets older, there is a decline in natural immunity and the virus can flair up again, presenting as shingles.”

Signs and Symptoms

The first symptoms of shingles usually include tiredness and headache, followed by abnormal sensations such as itching or tingling in one area of the skin. A few days later, a chickenpox-like rash develops, starting with red patches that go on to form clusters of small blisters. The shingles rash is characteristic, limited to the area of the skin that is supplied by the specific nerve either on the right or left side of the body, front and back, but not crossing the midline.

The skin usually returns to normal over a period of two to four weeks, but it can leave scarring and permanent changes in pigmentation. Pain levels can vary in intensity from mild to severe, where even a light touch or mere breeze crossing the skin can be unbearable.

Who is at risk for shingles?

There is no way to predict who will develop shingles or what may trigger the reactivation of the virus. However, a reduction in immunity occurs naturally with advancing age or may be caused by illness or some types of medical treatments. Consequently, the risk of shingles increases as one gets older and likelihood of persistent pain increases dramatically after the age of 50.

Read: Physiology of pain

“About one in three people who develop shingles may continue to suffer from chronic pain six months after the initial illness”, says Dr Pearl. “We call this prolonged pain postherpetic neuralgia or PHN.  This chronic pain is debilitating and can lead to other consequences like sleeping problems, depression and social withdrawal.”

“Depending on the nerves involved and the severity of the illness, other complications can also occur”, says Dr Glass. “The worst of these include paralysis, stroke or blindness.”

Shingles pain can be very difficult to treat

Dr Milton Raff is the director of the Christian Barnard Memorial Hospital Pain Clinic in Cape Town and specialises in treating chronic pain. “The problem with shingles-related pain”, he says, “is that it is so difficult to treat. Because it is pain resulting from affected nerves that function abnormally, regular pain medications are not effective. We only have a few specialised medications we can try. If these prove to be ineffective, then the pain can be incapacitating. In a small proportion of patients, the pain never goes away. Not only does the patient suffer severe pain, they can often not perform routine everyday tasks.”

Commonly used medicines to treat shingles, including chronic pain of shingles, include antivirals and medicines for neuropathic pain.  The cost of these medicines in the private sector can reach approximately ZAR 800 per month.

Shingles can be prevented

There is good news, though. Recently a shingles-specific vaccine has been developed. “This is a major breakthrough”, says Dr Raff. Studies show that the vaccine can prevent the development of shingles in up to 7 out of 10 people who would have got it had they not been vaccinated, and it significantly reduces the occurrence or severity of pain among vaccinated individuals who do get shingles.

Read: Panel backs shingles vaccine

In South Africa, children can be vaccinated against chickenpox as part of their routine vaccination schedule. “Now that the new vaccine is available, it is just as important for adults over 50 to be vaccinated against shingles”, says Dr Raff. “I would recommend that everyone over the age of 50 should speak to their doctor about getting vaccinated.”

Read more:

Shingles vaccine is safe

Herpes zoster (shingles)

People with shingles have a higher stroke risk

References:

1. Gnann JW, Whitley RJ. Herpes Zoster. N Engl J Med 2002; 347(5): 340-346.

2. Roxas MR. Herpes zoster and postherpetic neuralgia: Diagnosis and therapeutic considerations. Alt Med Rev 11(2): 102-113.

3. Schmader KE, Levin ML, Gnann JW, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in persons aged 50-59 years. Clin Infect Dis 2012; 54(7): 922-928.

4. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352(22): 2271-2284.

5. DOH SEP Price List – Database of Medicine Prices 19th Aug 2014

6. MIMS Indices Volume 54 Number 5 June 2014

Image: Patch of shingles from Shutterstock

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