Epidural Shot No Fix for Shingles Pain
No Lasting Benefit Seen in Study of Shingles Patients
Jan. 19, 2006 -- Getting a shot of steroids and anesthetics into the spine is "not effective" at preventing long-term shingles pain, Dutch doctors write in The Lancet.
They report that pain relief faded within a month after the shot, called an epidural.
"The effect of the epidural injection was strongest during the first week and did not last beyond one month," write the researchers. They included Albert J.M. van Wijck, MD, of the pain clinic at University Medical Center Utrecht in the Netherlands.
Shingles is an infection caused by the same virus that causes chickenpox, the varicella-zoster virus. It results in a rash that can be mildly itchy to intensely painful.
Shingles occurs in people who have already had chickenpox. In those people, the varicella-zoster virus becomes active again after lying dormant in the body. Shingles is most common in older adults but can also occur in younger people if their immune system is impaired.
The Dutch study included nearly 600 people aged 50 and older with shingles. Since treatments are most effective in the early stages of the disease, the study identified people whose rashes had only been present for less than a week. All participants got antiviral pills and painkillers; they took those drugs by mouth. Half of the group also got a single epidural shot of a steroid and anesthetic.
Before treatment and over the next six months, participants regularly rated their shingles pain on a scale ranging from "no pain" to "worst pain ever experienced."
For the first four weeks after treatment, the epidural group's pain ratings were better than those who got standard treatment. But after a month, that advantage was gone.
The epidural shot had a "modest" effect for one month, write van Wijck and colleagues. However, there are significant risks involved with epidurals.
An epidural injection involves putting a needle into the space between the layers covering the spinal cord. In the study, 11% of the people who received the epidural had complaints about the injection.
The authors conclude that since the benefits didn't last beyond a month, the epidural shot they used should only be considered for severe, acute shingles pain not eased by standard pain treatments.
A journal editorial notes that ideally, a study would compare epidural shots with placebo shots.
The Dutch researchers write that they decided using placebo epidural shots would be "unethical" and possibly too risky for patients.
The editorialist, Ralf Baron, MD, of the neurology department at Germany's Universitatsklinikum Schleswig-Holstein, writes that combining several types of medicines may be the biggest help in treating most shingles patients.
He also concludes that the prevention of shingles -- and the long-term pain that sometimes follows -- might occur in the future through the widespread use of childhood vaccination and the use of a booster vaccination in senior citizens.