$Unique_ID{BRK02067} $Pretitle{} $Title{Medications and Treatments for Dealing with Shingles} $Subject{shingles herpes zoster virus nerve skin lesions herpetic neuralgia postherpetic neuralgia tranquilizers psychotropics analgesics narcotics transcutaneous electrical nerve stimulation TENS amantadine sympathetic nerve blocks Cimetidine famotidine gastric ulcer histamine H2-receptor antagonists aspirin chloroform topical capsaicin Dorsal Root Entry Zone Lesion DREZ pain receptors Tricyclic antidepressants amitriptyline imipramine depression Carbamazine prescription} $Volume{} $Log{} Copyright (c) 1993 Tribune Media Services, Inc. Medications and Treatments for Dealing with Shingles ------------------------------------------------------------------------------ QUESTION: You recently discussed shingles in your column and mentioned that there were a number of medications that could be used for pain. I had this vicious ailment several months ago, but though the rash is gone, the pain is still very much with me. Is there anything you can offer to help me? This is a very difficult pain to bear, and I would be so very grateful if you can provide me with something that could help. ------------------------------------------------------------------------------ ANSWER: You are not alone, if the volume of mail I have received since that column is any indication of the frequency with which the pain of shingles goes on after the acute phase. Shingles (or herpes zoster) is a most painful inflammatory eruption of the skin, caused by a virus attacking the nerve. When both pain and skin lesions are present at the same time, the pain is called "herpetic neuralgia". Pain that continues after the disappearance of the rash is known as "postherpetic neuralgia," is most common in older patients, and is a frustrating problem for both patient and physician. Despite all that has been written about this, there is no agreement amongst physicians as to just what the best course of therapy might be. In each case a personalized decision must be made, based upon the severity of the pain, how much it is affecting the life style of the patient, and the kinds of medications that have been tried and failed. This must be balanced against the side effects that some types of treatment may also bring about. Many medications and treatments have been used with varying degrees of success. They include tranquilizers, psychotropics, analgesics and narcotics, transcutaneous electrical nerve stimulation (TENS), amantadine, and sympathetic nerve blocks. Here are some other agents which have been written about lately and may offer a new source of help. Cimetidine and famotidine: These medications are well known as treatments for gastric ulcer, and are technically histamine H2-receptor antagonists. Though their action in relieving postherpetic pain is still unknown, cimetidine (300 mg 30 minutes before each meal and at bedtime, and famotidine (40 mg at bedtime) have been found to offer relief. Topical aspirin: two 350 mg tablets of aspirin crushed into chloroform, or using Vaseline Intensive care lotion, and applied locally to the painful areas have been found effective in some people. Topical capsaicin: This medication in ointment form, used 4 to 5 times a day for no less than 4 weeks, provides analgesia. The application of the ointment can cause a feeling of burning on the skin for a short period after application. Dorsal Root Entry Zone Lesion (DREZ): This procedure creates a scar in the spinal cord in an area that contains pain receptors, and can relieve the pain of postherpetic neuralgia. Tricyclic antidepressants: Both amitriptyline and imipramine are medications used to treat depression. However, in doses of 75-150 mg a day, they are sometimes useful in treating the pain that persists after shingles. While much of the scientific literature concerns these two medications, it is probable that all tricyclics would have the same effect. Carbamazine: This medication is an anti-convulsant, but in dosages from 400-800 mg a day, has brought relief to some patients with postherpetic neuralgia. Caution! All of the above treatments must be managed by your physician and require powerful medications obtainable by prescription only. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.