What Is It?

Herpes Zoster is caused by the chicken pox virus. After having chicken pox, the virus lies inactive within your nervous system. Even though you recover from chicken pox, the virus is never completely destroyed. Instead it is held in check by your immune system.

Later in life, an illness or stress may weaken the immune system, allowing the virus to reactivate. This time, the virus spreads along the course of one or more nerves until it reaches the nerve endings in the skin. There it erupts in a chain of red painful blisters. This condition is commonly called shingles.

Shingles most commonly appears on the chest or abdomen, but may occur on any part of the body, including the face. The most significant symptom of shingles is severe, unrelenting, burning pain along the course of the affected nerve. The pain occurs several days before the blisters appear. The blisters crust over and will break within 2 to 3 weeks and then slowly heal. The skin sometimes is permanently scarred in the area of the outbreak.

If the severe pain of shingles persists after the skin eruptions have healed, the condition is called post herpetic neuralgia (PHN). The risk of getting PHN increases with age. Before the age of thirty the risk of PHN is less than 10%. By age 60 the risk of PHN increases to about 50%. The severe pain of PHN may last for several years. It is a major cause of suicide in the elderly.

Is It Contagious?

The blisters contain the active chicken pox virus which may cause chicken pox in someone who has not had chicken pox or had the vaccine. Coming in to contact with someone with shingles will not increase the likelihood of getting shingles itself.

How Is It Treated?

Mild cases of shingles in persons under the age of 60 are treated with anti-viral medications. These drugs reduce the severity of the skin eruptions and allow them to heal faster. Antiviral medications alone do not relieve shingles pain. In many cases a skin cream prepared from capasaicin, a hot pepper extract is helpful in controlling pain.

Sometimes, strong pain medications are required for relief. Local anesthetic nerve blocks performed by a pain medicine specialist may be prescribed if:

• The pain is not well controlled by the medications.

• The skin eruptions involve the eye or cover a large part of the body's trunk.

• The person is over the age of 60 and therefore at risk for prolonged pain from post herpetic neuralgia.

How Do Nerve Blocks Work?

Local anesthetic drugs injected around the affected nerves immediately block the pain caused by the viral infection. This effect lasts 12 to 24 hours. These drugs also increase blood flow to the injured nerves which reduces nerve damage and hastens recovery.

What Nerve Blocks Are Used?

The choice of nerve blocks depends upon the location of the shingles. If the head, neck or arms are involved, an injection is performed at the base of the neck just above the collarbone. This is called a stellate ganglion block. If the chest, trunk or lower extremities are involved, an epidural block is performed in the back.

Your pain management specialist can explain the details of these procedures to you. Due to the precision with which the blocks are performed, it is possible to get pain relief without unwanted weakness or numbness in the affected area. Repeating the blocks two or three times within a two week period will usually give long term pain relief, provided the nerve block therapy is started soon enough after the appearance of symptoms.

Can Post Herpetic Neuralgia Be Prevented?

No medication has been found effective in preventing PHN. Recent studies suggest that nerve block therapy is effective in preventing PHN, but only if administered within a month or so after the initial shingles outbreak. For this reason, prompt initiation of treatments is essential to reduce the risk of developing this very painful condition.

How Can I Receive Proper Treatment?

Your primary care physician will prescribe the medication and if necessary will refer you to a pain management specialist for appropriate nerve block therapy. Before treatment, the pain management specialist will discuss the particular type of nerve blocks to be used and the details and timing of the procedures. He or she may also suggest additional medications if needed. In most cases, prompt and comprehensive treatment will result in rapid resolution of symptoms and minimize the risk of prolonged pain or disability.