Shingles disease treatment, reactivation, reduction of symptoms and pain relief
by Ray Sahelian, M.D.
April 1 2018
Shingles is a disease caused by the reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After an attack of chickenpox, the virus lies dormant in certain nerve tissue. Shingles is characterized by clusters of blisters, which develop on one side of the body and can cause severe pain that may last for weeks, months or years after the virus reappears. For more research in the area of natural shingles prevention or treatment, particularly with natural supplements, consider signing up to a free email newsletter medicine. You may also consider taking steps to naturally improve your immune system so you are less likely to have a recurrence.
Shingles can begin due to the aging process, due to trauma or from stress which interferes with the proper functioning of the immune system. As people age, it is possible for the virus to reappear in the form of shingles, which is estimated to affect 1 in every 5 people in their lifetime.
The combination of methotrexate and biologics for the treatment of psoriasis may increase the risk of herpes zoster infection, according to a large, database cohort study published in JAMA Dermatology, 2015.
Risk for stroke and heart problems
People who have had an attack of shingles involving the eyes may have a heightened risk of stroke for a year afterward. Neurology, online March 3, 2010.
J Med Virol. January 30 2014. Increased risk of cardiovascular events in patients with herpes zoster: A population-based study.
Pain medication for post herpetic neuralgia
The most common treatments for shingles are:
Antiviral medicines, such as acyclovir, famciclovir, or valacyclovir, to reduce the pain and the duration.
Over-the-counter pain medicines, such as acetaminophen, aspirin, or ibuprofen, to help reduce pain during an attack of shingles.
Topical antibiotics, applied directly to the skin, to stop infection of the blisters.
Corticosteroids also may be used to reduce pain in people younger than 50 who have had a recent outbreak of shingles.
Early treatment of the infection and the pain may reduce the risk for post-herpetic neuralgia. Once PHN has developed, current treatments offer only limited benefit and adverse effects are common.
Treatment to reduce the pain of postherpetic neuralgia includes:
Antidepressant medicines, such as a tricyclic antidepressant (for example, amitriptyline).
Topical anesthetics, such as lidocaine patches, to numb the area.
Anticonvulsant medicines, such as gabapentin or pregabalin.
Opioids, such as codeine.
Topical creams containing capsaicin may provide some relief from pain. Capsaicin may irritate or burn the skin of some people, and it should be used with caution.
Interventional treatments, such as epidural injections of corticosteroids and local anesthetic drugs, have an effect on the acute pain but are of limited use in preventing post-herpetic neuralgia. When conservative treatment fails in providing satisfactory relief of post-herpetic neuralgia, a sympathetic block may be considered.
Shingles pain can stop people from working, or enjoying their hobbies, and it can also make some people depressed or anxious. Dr. Robert Dworkin, from the University of Rochester School of Medicine and Dentistry, New York, evaluated the pain-relieving potential of oxycodone and gabapentin, which both effectively treat pain associated with nerve damage. Those taking oxycodone were more than twice as likely to experience a meaningful reduction in their pain - at least a 30 percent decrease - compared to their counterparts taking a placebo. Though the medication was effective, nearly one-third of the participants on oxycodone withdrew from the study, mainly because of problems with constipation. This pain medication can also cause nausea and vomiting. Dr. Robert Dworkin found that gabapentin was not effective for pain relief. Pain, April 2009.
Lidocaine 5% medicated plaster: a review of its use in postherpetic neuralgia. The lidocaine 5% medicated plaster (Versatis) is a topical analgesic, indicated for the symptomatic relief of neuropathic pain associated with previous herpes zoster infection PHN] in adults. The lidocaine 5% medicated plaster has a direct local action with low systemic exposure and is effective in the treatment of patients with PHN. Limited data show that short-term treatment with lidocaine 5% medicated plaster was associated with numerically higher pain intensity response rates than pregabalin.
received 1000 mg of valacylovir hydrochloride 3 times a day for 7 days plus
gabapentin at an initial dose of 300 mg/d, titrated up to a maximum of 3600
mg/d. The combination of gabapentin and valacyclovir administered acutely in
patients with herpes zoster reduces the incidence of postherpetic neuralgia.
Arch Dermatol. 2011.
Incidence of Postherpetic Neuralgia After Combination Treatment With Gabapentin and Valacyclovir in Patients With Acute Herpes Zoster:
Int J Dermatol. 2011. Cryoanalgesia for post-herpetic neuralgia: a new treatment.
The aim of this study was to try a new treatment modality for post-herpetic neuralgia. A spray of liquid nitrogen (LN) was used in 47 patients suffering from PHN as a stimulator of a mechanism not yet completely understood. The LN spray was carefully applied (so as not to freeze the skin surface) along the diseased sensory nerve dermatome, at weekly sessions lasting for 30 seconds each, with a mean of three applications per patient. The area corresponding to the dermatomes affected by the herpes zoster satisfactorily attenuated the herpetic neuralgia in all patients. Before the sixth treatment session, good or excellent improvement was obtained in 94% of the study patients. Pain was eliminated with one session in nine patients (19%), and with two sessions in eight patients (17%). We conclude that this non-freezing technique is absolutely safe and injury-free, and is very efficient in calming PHN.
Zostavax Shingles Vaccine
In May, 2006, the Food and Drug Administration licensed Zostavax, a new vaccine to reduce the risk of shingles (herpes zoster) for use in people 60 years of age and older. Zostavax is manufactured by Merck & Co., Inc., of Whitehouse Station, New Jersey. Zostavax, a live virus vaccine, was shown to boost immunity against varicella-zoster virus. This is thought to be the mechanism by which the vaccine protects against zoster and its complications. The vaccine is given as a single injection under the skin, preferably in the upper arm. Zostavax was studied in approximately 38,000 individuals throughout the United States who were 60 years of age and older. Of these 38,000 people, half received Zostavax and half received a placebo. All study participants were then followed for an average of three years to see if they developed shingles and, if they did, how long the pain lasted. At the conclusion of the study, researchers found that, overall, in those ages 60 and above the vaccine reduced the occurrence of shingles by about 50%. For individuals ages 60-69 it reduced occurrence by 64%. In addition to preventing approximately half of the cases, the duration of pain following the onset of shingles was slightly reduced in people who developed the disease–despite being vaccinated with Zostavax.
May 16, 2008 -- The US Centers for Disease Control and Prevention (CDC) has recommended that people aged 60 and older should be vaccinated against shingles, or herpes zoster, via the herpes zoster virus vaccine, Zostavax.
November 2009 -
Children who get vaccinated against chickenpox may have a lower risk of
developing shingles, a painful rash caused by the chickenpox virus. Pediatric
Infectious Diseases Journal, December 2009.
Zostavax side effects
The most common side effects in people who received Zostavax were redness, pain and tenderness, swelling at the site of injection, itching and headache. The percent of significant adverse events observed in the study were not different between persons who received the vaccine versus placebo.
As part of the development program, a smaller study was conducted to look more closely at safety. In this smaller study, serious adverse events for all age groups were noted more frequently in those who received Zostavax (1.9%) than those who received placebo (1.3%). Although FDA has concluded that the available data do not establish that these events are related to the vaccine, the manufacturer will perform a Phase 4 (postmarket) study to provide additional safety information.
Emails received, questions and answers
I just wanted to write and let you know that I used apple cider vinegar orally and topically to cure my very painful shingles! I didn't realize that I had shingles until it was too late to take the prescribed medicine so I searched for a natural cure. I found MANY sites that claimed that ACV cures shingles and gets rid of the pain. I figured I had nothing to lose and was in a lot of pain at this point (I am 37 and my shingles were on my ribs about 3 inches under my arm pit). At the point that I decided to use the apple cider vinegar, my bumps had just started to appear but had not yet blistered. I read that shingles usually lasts 5-6 weeks and then the pain can persist for months after the bumps have healed. I began by soaking a gauze pad in the ACV and taped it directly over my bumps. It did sting at first but then I felt immediate relief from the searing and burning pain I had been having for the week prior. I changed the dressing 3times a day and also took ACV capsules orally 3 times a day (4 pills each time). By the next day, the bumps had formed blisters and by the following day, most had popped and were starting to scab over. WIthin 1 week, the bumps were completely flat and the pain/itching was gone. I am still taking the ACV orally and you can still see some of the bumps but there is NO PAIN. I just wanted to let you know so that you can let others know that apple cider vinegar DOES cure shingles even faster than the medicine that Drs typically prescribe!
I am skeptical but will keep an open mind.
Do you have a
regimen for post herpetic neuralgia?
I have not studied this topic well yet and do not have any solutions, natural or alternative, that are effective.
Hi Doc, I really
appreciate your website. Keep up the good work .I am a male now 62 years old. A
couple years back I had an outbreak of shingles. At that time I did some
investigation regarding natural supplement defense and read a number of articles
referring to the benefits of
Lysine. I did employ Lysine then but was well into the outbreak and still
dealt with it for about 4 weeks, although I have to admit that my suffering
seemed to be far less than others have reported. It only seemed like a bad
sunburn. Fast forward to a few months ago and waking up to a rash in similar
areas to where my shingles episode had been. It sure seemed like a revisit, but
this time as soon as I felt the first effects I took 500mg of Lysine four times
that first day. The next day the rash was gone completely as if it never
existed. I continued the Lysine that day and then stopped. I realize the purely
anecdotal nature of my report, but I thought it might be helpful in the ongoing
Over 15 years ago
(I was in my late 20's), I was prescribed itraconazole (Sporanox) to address
toenail fungus. I forgot the dosage, but I think it was well within the normal
guidelines. I was, and still am, a fairly healthy person: I exercise daily,
played a lot of tennis and other sports, ate a balanced diet, took a simple
daily multivitamin, and went to the doctor 2x a year for checkups. I didn't
drink (well, maybe 1 or 2 glasses ofwine a month), and definitely didn't smoke.
I started taking the Sponranox, and about a month later, I got this red somewhat
painful rash, first on my back, then wrapping around like a wide belt around my
whole waistline area. At first, I thought it was an allergy or I walked into a
poison ivy bush, and that it would clear in a few days. It didn't. I took
Benadryl, hoping that the rash would lessen, and it didn't. So finally, when I
went to my doctor, she said that I had contracted shingles. She prescribed an
antiviral, and said to stop all other medications, and rest the same way as one
would when contracting chickenpox. After a few weeks, the rashes dried up, and
although there was a bit of pain, I managed to get back to my normal life. Have
you ever heard of similar cases of contracting shingles, when taking Sporanox or
other oral antifungals? Needless to say, I still have the nail fungus (which has
spread to 2 other toes), and I refuse to take any oral antifungal prescribed by
my podiatrist. I tried Joomla, applied it regularly, kept my nails clean, etc,
and it did nothing.
A. It is possible that long term use of antifungals could negatively influence the immune system but this is not an area of medicine that I have expertise on.