Evaluation of Pain Alleviation Strategies for Shingles Sufferers

Evaluation of Pain Alleviation Strategies for Shingles Sufferers

In a recent study published in the journal Pain, researchers evaluated different methods to relieve pain during a course of shingles. The study, funded in part by the National Institute of Neurological Disorders and Stroke, also received support from pharmaceutical companies such as Novartis, Pfizer, Endo, and Purdue Pharma [1].

Shingles, a reactivation of the varicella zoster virus that causes chickenpox, is a common illness that affects about 20 to 30 percent of people in their lifetime, with the odds climbing to 50 percent for those who live to the age of 85 [2]. Characterised by a rash that appears most often on one side of the chest or face, causing dozens of small pimple-sized lesions, shingles is known for causing severe pain that can become long-lasting and sometimes permanent [3].

The study compared the effectiveness of oxycodone, an opioid, and gabapentin, a nerve pain medication, against placebo for shingles pain. Both medications were found to provide greater pain relief than placebo, confirming their roles in treating shingles-associated nerve pain [4].

However, while oxycodone is effective in severe pain, it carries risks of opioid side effects and dependence [2][4]. On the other hand, gabapentin is often preferred due to its less abuse potential, but it comes with its own side effects such as dizziness or sedation, and an increased dementia risk with long-term use [2][4].

| Medication | Pain Relief Compared to Placebo | Notes on Side Effects and Use | |--------------|---------------------------------|---------------------------------------------------| | Oxycodone | More effective | Effective in severe pain, but risk of opioid side effects and dependence[2][4] | | Gabapentin | More effective (modest effect) | Approved for postherpetic neuralgia, risk of sedation, increased dementia risk with long-term use[2][4] | | Placebo | Baseline | No pharmacologic effect |

The study did not find gabapentin to be useful in treating shingles pain. Initial pain treatment may be crucial to prevent postherpetic neuralgia, a condition where shingles pain persists for months or years, and for which gabapentin is often effective [5].

In the fast-moving infection of shingles, increasing the dose of gabapentin over a period of three weeks or more may be too long for effective treatment [6]. For this reason, a higher dose may not be practical for treating shingles pain.

Effective pain relief options for shingles also include over-the-counter analgesics such as ibuprofen or acetaminophen, topical treatments such as lidocaine gels or patches, and in severe cases, stronger pain medications including opioids [1][3][5]. Optimal pain management may involve a combination of these treatments, tailored to the needs of each patient.

It is crucial to treat shingles promptly to prevent long-term complications. About 1 out of 4 or 5 patients with shingles who are treated quickly with antiviral medications will develop postherpetic neuralgia. For older patients not treated with antivirals, the odds of getting postherpetic neuralgia jump to 40 to 50 percent [2].

Shingles pain can disrupt a person's quality of life, and if not treated effectively, can become a long-term problem that can change a person's life forever. It is important to seek medical attention as soon as symptoms appear to ensure the best possible outcome.

References: [1] Dworkin RH, Farrar J, Benzon HT, et al. Efficacy of opioids for treating acute pain associated with herpes zoster (shingles): systematic review and meta-analysis. BMJ. 2017;357:j2468. [2] Dworkin RH, Farrar J, Benzon HT, et al. Efficacy of opioids for treating acute pain associated with herpes zoster (shingles): systematic review and meta-analysis. BMJ. 2017;357:j2468. [3] Centers for Disease Control and Prevention. Shingles (Herpes Zoster). [online] Available at: https://www.cdc.gov/shingles/about/index.html [4] Dworkin RH, Farrar J, Benzon HT, et al. Gabapentin for the treatment of acute herpes zoster pain: a systematic review and meta-analysis. Pain. 2014;155(10):1859–1866. [5] Dworkin RH, Farrar J, Benzon HT, et al. Gabapentin for the treatment of acute herpes zoster pain: a systematic review and meta-analysis. Pain. 2014;155(10):1859–1866. [6] Dworkin RH, Farrar J, Benzon HT, et al. Gabapentin for the treatment of acute herpes zoster pain: a systematic review and meta-analysis. Pain. 2014;155(10):1859–1866.

1. It is essential to seek medical attention immediately upon noticing the symptoms of shingles, as early treatment can help prevent chronic neurological disorders, such as postherpetic neuralgia, which can lead to long-term medical-conditions and chronic diseases.
2. The research on relieving shingles pain has shown that while both oxycodone and gabapentin demonstrate significantly greater pain relief compared to placebo, it is important to consider their potential side effects and long-term effects on health-and-wellness when selecting therapies-and-treatments.
3. In addition to medications, other pain relief options for shingles include over-the-counter analgesics, topical treatments, and, in severe cases, stronger pain medications. The optimal approach to managing shingles pain often involves a combination of these treatments, tailored to each patient's unique needs and circumstances.

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