FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER SHOULD SEEK CONSULTATION ON CONTINUING SHINGLES PAIN

Question: I had sharp pain that began under the shoulder blade on my right side. The pain radiates clear around onto my side and under my breast. About two days after the pain started, blisters developed in the same area. My doctor diagnosed this as shingles and has been treating me for it for the past 14 months. I have taken several medicines without much help. I still have blisters and pain. How common is it for shingles to last this long?

Answer: Before I answer your question, I want to explain a bit about shingles. If you are a regular reader of this column, you may remember some of this background from a column a few months ago that answered another reader's question about the initial treatment for shingles. Consider this a refresher course.

The varicella-zoster virus (VZV) causes several illnesses, including shingles. A person's first exposure to the virus produces chickenpox with its itching, irritated blisters and fever. Well over 90 percent of adults have had this infection. This common childhood illness usually clears up within a few days without any complications.

However, our body's defense system can't actually kill off the attacking chickenpox virus; it only holds it under control. As the chickenpox sores go away, the virus actually goes into hiding along the nerve pathways -- a state you can think of as hibernation. When the immune system becomes less active, the virus begins to stir again. The weakening of immunity is often simply a natural byproduct of aging, but it can also be caused by diabetes, AIDS, other health conditions and the use of some medications.

When or if the VZV becomes active again, it does so along the course of the infected nerves instead of producing a generalized or "body wide" rash like the original case of chickenpox. This produces blisters that are typical of shingles. And as you know, shingles blisters are painful. In fact, the pain may precede the eruption of blisters by a few days.

Shingles blisters are quite distinct in that they follow the course of one or two nerves. The nerves of the chest are most commonly involved, just as you have experienced, but any part of the skin may be so afflicted. In typical cases, the blisters don't go beyond the midline of the body in the front or back, just as the picture of your condition that you sent me shows.

Treatment of shingles involves taking one of several different medicines that help slow the virus, but we don't have a drug that actually kills it. To be effective, the medicine must be started within two days after the onset of blisters. The other part of therapy involves aggressive treatment of pain. Both of these steps are designed to reduce the major complication of shingles -- pain that persists after the blisters are gone, a condition we doctors call post herpetic neuralgia.

Unfortunately, the treatments we have today for VZV infections are not perfect. A few unlucky individuals -- which, unfortunately, includes you -- just don't recover very quickly. There are no good solutions for this dilemma. However, I think it would be worthwhile to have a consultation with an expert in infections diseases just be sure that you have been given the best treatment we have available today.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.