Shingles and Postherpetic Neuralgia
Also indexed as: Herpes Zoster (Shingles)
The virus that triggers chickenpox also causes shingles. Although
no cure exists, treatments are available to relieve the rash and nerve pain. According to
research or other evidence, the following self-care steps may be helpful:
- Consider a topical ointment
- To soothe pain, apply an ointment containing capsaicin, a
substance found in cayenne peppers, four times a day
- Try peppermint oil
- Apply 2 to 3 drops to the affected area three or four times per
day for pain relief
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full shingles article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About shingles
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.
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What are the symptoms?
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 options
Over-the-counter treatment for shingles might include analgesics, such as aspirin (Genuine Bayer®, Bufferin®,
Ecotrin®), ibuprofen (Motrin IB®,
Advil®), naproxen (Aleve®) 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
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
Stress and depression have been linked to
outbreaks of shingles in some,2 3 but not all,4 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 shingles 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.
Vitamins that may be helpful
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?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
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?
Refer to the individual herb for information about any side effects or interactions.
Holistic approaches that may be helpful
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
References:1. Tankersley RW Jr. Amino acid requirements of herpes simplex virus in
human cells. J Bacteriol 1964;87:609–13.
2. Irwin M, Costlow C, Williams H, et al. Cellular immunity to
varicella-zoster virus in patients with major depression. J Infect Dis 1998;178
(Suppl 1):S104–8.
3. Engberg IB, Grondahl GB, Thibom K. Patients’ experiences of
herpes zoster and postherpetic neuralgia. J Adv Nurs 1995;21:427–33.
4. Schmader K, George LK, Burchett BM, Pieper CF. Racial and psychosocial
risk factors for herpes zoster in the elderly. J Infect Dis 1998;178 (Suppl
1):S67–70.
5. Schmader K, Studenski S, MacMillan J, et al. Are stressful life events
risk factors for herpes zoster? J Am Geriatr Soc 1990;38:1188–94.
6. Gupta MA, Gupta AK. Herpes zoster in the medically healthy child and
covert severe child abuse. Cutis 2000;66:221–3.
7. Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin
treatment of chronic postherpetic neuralgia. J Am Acad Dermatol
1989;21:265–70.
8. Sklar SH, Blue WT, Alexander EJ, et al. Herpes zoster. The treatment
and prevention of neuralgia with adenosine monophosphate. JAMA
1985;253:1427–30.
9. Sklar SH, Wigand JS. Herpes zoster. Br J Dermatol
1981;104:351–2.
10. Schiller F. Herpes zoster: review, with preliminary report on new
method for treatment of postherpetic neuralgia. J Am Geriatr Soc
1954;2:726–35.
11. Heyblon R. Vitamin B12 in herpes zoster. JAMA 1951;146:1338
(abstract).
12. Ayres S Jr, Mihan R. Post-herpes zoster neuralgia: response to
vitamin E therapy. Arch Dermatol 1973;108:855–66.
13. Ayres S Jr, Mihan R. Post-herpes zoster neuralgia: response to
vitamin E therapy. Arch Dermatol 1975;111:396.
14. Cochrane T. Post-herpes zoster neuralgia: response to vitamin E
therapy. Arch Dermatol 1975;111:396.
15. Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin
treatment of chronic postherpetic neuralgia. J Am Acad Dermatol
1989;21:265–70.
16. Bernstein JE, Bickers DR, Dahl MV, Roshal JY. Treatment of chronic
postherpetic neuralgia with topical capsaicin. J Am Acad Dermatol
1987;17:93–6.
17. Davies SJ, Harding LM, Baranowski AP. A novel treatment of
postherpetic neuralgia using peppermint oil. Clin J Pain 2002;18:200–2.
18. Baba M, Shigeta S. Antiviral activity of glycyrrhizin against
varicella-zoster virus in vitro. Antivir Res 1987;7:99–107.
19. Coghlan CJ. Herpes zoster treated by acupuncture. Cent Afr J
Med 1992;38:466–7.
20. Lewith GT, Field J, Machin D. Acupuncture compared with placebo in
post-herpetic pain. Pain 1983;17:361–8.
21. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol
2000;136:393–9.