What is shingles
Herpes zoster is a dermatological disease caused by the varicella virus and is characterized by painful banding along the nerves and a skin rash. In ancient medical books, it was mostly named as “herpes zoster”, “herpes snake”, “herpes spider”, “herpes zoster”, etc. Why does shingles occur?
Why does herpes zoster occur?
The main reason is that chickenpox was contracted in childhood, and although the chickenpox was cured, the chickenpox virus lurks in the nerve cells of the posterior spinal root ganglion, the semilunar ganglion, and the geniculate ganglion, and becomes active again when the host organism’s immunity decreases, spreading along the peripheral nerves and into the skin, resulting in herpes zoster. This means that people who have been infected with chickenpox have a chance of developing shingles, and the incidence is about 15%. However, the incidence of shingles is five to ten times higher in risk groups with poor immune function, such as people over 60 years old, diabetics, patients with malignant tumors, AIDS patients, and people who are stressed and overworked.
Symptoms of shingles
The typical symptoms of shingles are blistering rashes that appear in patches or bands on one side of the body, accompanied by severe pain and other abnormal sensations. It usually occurs on the chest, followed by the head and lower abdomen, and usually only on one side of the body.
Treatment of shingles
During the acute phase of a shingles attack, the patient may feel itchy discomfort and burning pain in the affected area. Treatment should include pain management in addition to careful care of the blisters to prevent infection and oral or intravenous antiviral agents. This includes pharmacological treatments such as analgesics, steroids, antidepressants, sedatives, ultra-laser therapy, and nerve blocks.
Understanding postherpetic neuralgia
Postherpetic neuralgia is a persistent pain in the area of the skin that remains after the herpes has disappeared, usually lasting from 3 to 6 months, and in some cases up to several years. The incidence of postherpetic neuralgia in young patients is about 10%. The incidence increases significantly with age, with the incidence of postherpetic neuralgia ranging from 15% to 70% in patients over 50 years of age, and up to 50% to 75% in patients over 60 years of age.
Symptoms of postherpetic neuralgia
Neuralgia is caused by nerve damage, and this pain is usually very severe. Neuralgia takes diverse forms and the pain is felt differently in different patients. Patients often use the following words to describe neuropathic painU
electric shock sensation, squeezing sensation, burning sensation, cone stinging sensation, glass stabbing sensation, paroxysmal pain sensation, etc. Some patients also have some other abnormal sensations such as extreme coldness and numbness.
Factors affecting postherpetic neuralgia
Peripheral neuropathy
Peripheral nerve damage can be caused during the onset of herpes zoster, contributing to the persistent pain of postherpetic neuralgia.
Central nerve abnormalities
Because one of the complications of herpes zoster is aseptic meningitis, it suggests that herpes zoster may involve the central nervous system along with peripheral neuropathy. The persistence of postherpetic neuralgia despite clinical treatment of refractory postherpetic neuralgia with neurogenotomy may also indicate a central cause.
Psychosomatic factors
Some psychiatric symptoms, one of the complications of herpes zoster, can always accompany postherpetic neuralgia, such as insomnia in 25% of patients and mental distress (helplessness and depression) in 20%; more elderly patients older than 50 years of age with insomnia, accounting for 30%, are significantly more than younger patients under 40 years of age.
Treatment of postherpetic neuralgia
1.Medication
(1) Analgesic drugs
General anti-inflammatory painkillers, even if the patient takes a fairly high dose, and even eat until the gastrointestinal side effects are revealed, can only play a little relief effect on postherpetic neuralgia; morphine is better, but the postherpetic neuralgia is often up to a year or more, so the side effects of morphine must be considered in the case of long-term use.
(2) Corticosteroids
Corticosteroids can inhibit the inflammatory process and reduce post-inflammatory fibrosis in the spinal ganglia. They are applied in patients without contraindications as early in the disease as possible when the ganglion has not yet degenerated and become necrotic, usually within 7 days of onset. It is effective in reducing the occurrence of postherpetic neuralgia, although the effect is not obvious at the immediate end of treatment, but it has the potential to disseminate the disease in patients with immunodeficiency and should be used with caution.
(3) Anti-epileptic drugs
Anti-epileptic drugs can inhibit the phenomenon of abnormal discharge of nerve cells and relieve the discomfort of cramps in post-herpetic neuralgia. However, anti-epileptic drugs can damage the liver, kidneys, heart, and inhibit bone marrow function as side effects, and users must undergo follow-up examinations such as liver function tests and electrocardiogram and white blood cell count tests every six months to one year to ensure health.
(4) Antidepressants
They can increase the concentration of pain-relieving substances in the brain, and can exert a relieving effect on the deep burning pain in posterior neuralgia. However, it must be emphasized that antidepressants are not effective at first, and side effects such as dry mouth and dizziness may occur at the beginning of the course of treatment. It is best to take antidepressants at night, and the dose should be adjusted every three days and increased one by one, rather than taking a high dose at once. Generally, patients should take them for at least three months; however, if they feel a little relief from the pain, they can discuss with their physician to stop taking the medication for a period of time, and if there are no more attacks during this period, they may be able to stop taking the medication.
Although there are some side effects associated with the long-term use of these medications, if the medication is taken according to the physician’s instructions, the best treatment effect will be obtained.
2.Physical therapy
Including ultra-laser, acupuncture, transcutaneous electrical stimulation and other treatments.
3.Interventional treatment
(1) Nerve block
In the early stage of postherpetic neuralgia, nerve block has certain effect. Stellate nerve block, epidural block, paravertebral nerve block and nerve trunk block can be applied according to the innervation of the pain site. It has been reported that within 3 months after the onset of herpes zoster, 70% to 80% of patients with sympathetic nerve block can have their pain reduced, but the effect of nerve block is significantly reduced in patients with refractory postherpetic neuralgia of longer duration.
(2) Nerve destruction therapy
For patients with refractory postherpetic neuralgia, nerve chemical destruction can be used when various methods are ineffective or the efficacy cannot be maintained, in order to achieve longer-term efficacy. 50% or 95% ethanol solution and 6% phenol glycerol are commonly used nerve destruction drugs. In addition, the antitumor drugs mitomycin, adriamycin hydrochloride and the pigmented agent melanocyte can cause reversible degeneration of nerve fibers and are used for destructive nerve block.
(3) Radiofrequency destructive therapy
Radiofrequency destruction of intracorporeal afferent nerves and sensory ganglia can be used for recalcitrant PHN, and the treatment should be carried out under the guidance of imaging. However, the efficacy of this treatment is still controversial, and those with successful experience recommend that the area of destruction should be in the damaged cortex and several segments above and below it ……
(4) Spinal nerve stimulation
This treatment can be considered for people with persistent PHN who have not been treated with the above methods. Through weak electrical stimulation to the spinal cord to inhibit or block the sensation of pain, most patients can obtain long-term definite and effective pain relief.
4.Psychotherapy
Patients often feel depressed and upset. Psychotherapy can help you overcome this psychological barrier and dispel the psychological stress caused by neuropathic pain. In addition, professionals may also teach you some methods to help reduce pain.
Prevention
1. The best way to prevent it: strengthen your immune system.
Shingles is caused by a decline in the body’s immune system, which allows the latent virus to take advantage of the spread of herpes; therefore, the best way to prevent it is to strengthen your immune system. Generally speaking, eating a normal diet, getting enough sleep, getting the right amount of vitamins and water, and getting into the habit of regular exercise are all ways to strengthen your immune system.
2, the virus can sometimes destroy the motor nerves to produce a sense of weakness.
Because the virus may destroy the motor nerve in addition to the sensory nerve, so there is a numbness and the inability to use force. If the patient has this kind of situation, should try to receive rehabilitation treatment to avoid muscle atrophy.
3. You can take a bath after the blisters have scabbed over.
Since the scab has been formed, of course, you can take a bath. However, it is important to emphasize that the wound should be cleaned before the blisters scab over to avoid bacterial infection.
4. Contact with blisters may still be contagious.
Generally speaking, the chance of transmission of shingles through daily contact is not high. However, some of the virus may still run into the blisters on the surface of the body, so it is best to do a good job of cleaning the patient’s surroundings after contact with the blisters to reduce the chance of being infected.
Post-herpetic neuralgia is a very painful condition that seriously affects the patient’s daily life, so if you or a family member suffers from neuralgia, please do not suffer in silence, as long as you are willing to receive active treatment, it will greatly help the progress of the disease and recovery. If you have any questions, please contact a neurologist or pain specialist who can provide you with the most comprehensive medical care.