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CD-ROM Today (UK) (Spanish) 15
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02067.txt
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1994-01-17
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$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
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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.