Related Items: Herpes Zoster (Shingles)
Shingles and Postherpetic Neuralgia Information
Shingles is a disease caused by the same virus (Varicella zoster) that causes
chicken pox. Acute, painful inflamed blisters form on one side of the trunk along a peripheral
nerve.
Shingles usually affects the elderly or people with compromised immune function. Nerve pain that persists after other
symptoms have cleared is called postherpetic neuralgia.
What are the symptoms of shingles?
Symptoms include pain, itching, or a
tingling sensation prior to the appearance of a severely painful skin rash of red,
fluid-filled blisters that later crust over. The rash is typically located on the trunk or
face and only affects one side of the body. Pain may resolve rapidly or persist in the area of
the rash for months to years after the rash disappears.
Medical treatments for shingles and postherpetic neuralgia
Over the counter treatment for shingles might include analgesics, such as aspirin (Bayer®, Bufferin®, Ecotrin®),
ibuprofen (Motrin®, Advil®), or acetaminophen (Tylenol®). Anti-itch creams
containing antihistamines (Caladryl®) and
hydrocortisone (Cortaid®, Lanacort®) might be useful. The oral antihistamine diphenhydramine (Benadryl®) might help
reduce inflammation and itching. Topical capsaicin (Zostrix®) may provide temporary
relief from postherpetic neuralgia pain.
Prescription drug treatment might include analgesics for pain relief, such as ibuprofen
(Motrin®), naproxen (Naprosyn®), and
acetaminophen with codeine (Tylenol® with
Codeine). Oral antibiotics such as cephalexin
(Keflex®) and amoxicillin/clavulanate (Augmentin®) might be used to treat infected
blisters. Other drugs used for short-term relief might include the antihistamine hydroxyzine (Atarax®); tranquilizers, such as lorazepam (Ativan®) and alprazolam (Xanax®); and oral corticosteroids, such as prednisone (Deltasone®)
and methylprednisolone (Medrol®).
Antiviral medicines such as oral acyclovir
(Zovirax®), famciclovir (Famvir®), foscarnet (Foscavir®), and valacyclovir (Valtrex®) may also be
prescribed.
Dietary changes that may be helpful for shingles and postherpetic neuralgia
Varicella zoster, the virus that causes shingles, is a type of herpes virus.
Another herpes virus, herpes simplex virus (HSV), has a high requirement for the amino acid arginine. On the other hand, lysine inhibits HSV replication.1
Therefore, a diet that is low in arginine and high in lysine may help prevent herpes viruses
from replicating. For that reason, some doctors advise people with shingles to avoid foods
with high arginine-to-lysine ratios, such as
nuts, peanuts, and chocolate. Nonfat yogurt and other nonfat dairy can be a healthful way to increase lysine
intake. This dietary advice for shingles has not been subjected to scientific study.
Lifestyle changes that may be helpful for shingles and postherpetic neuralgia
Stress and depression have been linked to
outbreaks of shingles in some2 3 but not all4 studies.
5 A small, preliminary study found that four children with shingles outbreaks, but who
were otherwise healthy, all reported experiencing severe, chronic child abuse when the
shingles first appeared.6 Among adults, how a stressful event is perceived appears
to be more important than the event itself. In one study, people with singles experienced the
same kinds of life events in the year preceding the illness as did people without the
condition; however, recent events perceived as stressful were significantly more common among
people with shingles.
Nutritional supplements that may be helpful for shingles and postherpetic neuralgia
Adenosine monophosphate (AMP), a compound
that occurs naturally in the body, has been found to be effective against shingles outbreaks.
In one double-blind trial, people with an outbreak of shingles were given injections of either
100 mg of AMP or placebo three times a week for four weeks. Compared with the placebo, AMP
promoted faster healing and reduced the duration of pain of the shingles.7 In
addition, AMP appeared to prevent the development of postherpetic neuralgia.8
9
Some doctors have observed that injections of
vitamin B12 appear to relieve the symptoms of postherpetic neuralgia.10
11 However, since these studies did not include a control group, the possibility of a
placebo effect cannot be ruled out. Oral vitamin B12 supplements have not been tested, but
they are not likely to be effective against postherpetic neuralgia.
Some doctors have found vitamin E to be
effective for people with postherpetic neuralgia—even those who have had the problem for
many years.12 13 The recommended amount of vitamin E by mouth is
1,200–1,600 IU per day. In addition, vitamin E oil (30 IU per gram) can be applied to
the skin. Several months of continuous vitamin E use may be needed in order to see an
improvement. Not all studies have found a beneficial effect of vitamin E;14
however, in the study that produced negative results, vitamin E may not have been used for a
long enough period of time.
Because shingles is caused by a herpes virus, some doctors believe that lysine supplementation could help people with the
condition, since lysine inhibits replication of herpes simplex, a related virus. However,
lysine has not been shown to inhibit Varicella zoster, nor has it been shown to
provide any benefit for people with shingles outbreaks. Therefore, its use in this condition
remains speculative.
Are there any side effects or interactions with Shingles and Postherpetic Neuralgia?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for shingles and postherpetic neuralgia
The hot component of cayenne pepper, known
as capsaicin, is used to relieve the pain of postherpetic neuralgia. In a double-blind trial,
a cream containing 0.075% capsaicin, applied three to four times per day to the painful area,
greatly reduced pain.15 In another study, a preparation containing a lower
concentration of capsaicin (0.025%) was also effective.16 Two or more weeks of
treatment may be required to get the full benefit of the cream.
One case report has been published concerning an elderly woman with postherpetic neuralgia
who experienced dramatic pain relief from topical application of 2 to 3 drops of peppermint
oil to the affected area 3 or 4 times per day.17 Each application produced almost
complete pain relief, lasting approximately 6 hours. The woman began to experience redness at
the site of application after four weeks of use. The oil was therefore diluted by 80% with
almond oil; the diluted preparation did not cause redness, and continued to produce "adequate"
though somewhat less-pronounced pain relief.
Licorice has been used by doctors as a
topical agent for shingles and postherpetic neuralgia; however, no clinical trials support its
use for this purpose. Glycyrrhizin, one of the active components of licorice, has been shown
to block the replication of Varicella zoster.18 Licorice gel is usually
applied three or more times per day. Licorice gel is not widely available but may be obtained
through a doctor who practices herbal medicine.
Wood betony(Stachys betonica) is a
traditional remedy for various types of nerve pain. It has not been studied specifically as a
remedy for postherpetic neuralgia.
Are there any side effects or interactions with Shingles and Postherpetic Neuralgia?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful for shingles and postherpetic neuralgia
Acupuncture may be helpful in some cases of
shingles and postherpetic neuralgia. Anecdotal case reports of people treated with
electroacupuncture (acupuncture with applied electrical current) described improvement in
seven of eight people.19 A controlled trial, however, found no difference in
response between acupuncture treatment and placebo.20 The authors of this trial
reported some difficulty in evaluating the results due to difficulty in assessing measures of
pain in this study group. Large, controlled trials using well-designed pain evaluation methods
are still needed to determine the value of acupuncture in the treatment of shingles and
postherpetic neuralgia.
Hypnosis has improved or cured some cases
of postherpetic neuralgia, as well as the acute pain of shingles.21
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The information presented in Healthnotes is for informational
purposes only. It is based on scientific studies (human, animal, or in
vitro), clinical experience, or traditional usage as cited in each article.
The results reported may not necessarily occur in all individuals. For many of
the conditions discussed, treatment with prescription or over the counter
medication is also available. Consult your doctor, practitioner, and/or
pharmacist for any health problem and before using any supplements or before
making any changes in prescribed medications.
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