Shingles: Are You Risking Nerve Pain?
Risk Factors for Nerve Pain After Shingles continued...
In one study published in the journal Neurology, researchers -- including Dworkin -- looked at data from 965 people with shingles. The researchers identified five risk factors for developing PHN in people who had been recently diagnosed with shingles:
- Presence of symptoms before the rash appeared, like numbness, tingling, itching, or pain
- Severe pain during the illness's initial stages
- Severe rash
Importantly, the researchers found the more risk factors you have, the greater the risk of developing PHN.
For instance, 17% of women with shingles and 26% of those who had severe pain went on to get PHN. But 50% of women who were over age 60 and had symptoms before the rash, severe rash, and acute pain went on to get PHN.
The Emotional Toll of Nerve Pain After Shingles
Researchers are not just looking at biological and neurological risk factors for PHN. Dworkin was also a co-author of a study looking at psychological risk factors, too. The results were published in the Journal of Pain in 2005.
"It certainly looks like psychological stress can be a potent risk factor for PHN," Dworkin tells WebMD.
The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.
Dworkin says previous studies have already shown a connection between stress and shingles development.
"One study even found that the risk of developing PHN was higher in people who were living alone when they developed shingles than people living with others," Dworkin says, perhaps indicating that social isolation increases the risks of PHN.
Preventing Nerve Pain After Shingles
But if you're worried about PHN, don't despair. There are medications that can cut your risks of getting the condition. There are three antiviral drugs used: famciclovir (Famvir), valacyclovir (Valtrex), and acyclovir (Zovirax). These medications need to be started within two to three days of the onset of shingles.
"If you look at the clinical trials with any of these drugs in people over 50," says Dworkin, "they cut the rate of pain at six months in half. That's a very significant improvement." They are also very safe and have few side effects, he says.
But who needs the drugs? Dworkin says there's not a clear consensus yet.
There are some obvious cases. "I think everyone would agree that someone who is over 50 and has severe symptoms should get preventative treatment," he tells WebMD.
But for younger people or those with fewer risk factors, the course is less clear.
"Some people think that everyone who gets shingles should get preventative treatment with antiviral medicines, because the medicines are so safe and have such few side effects," he says.
Others argue that preventative treatment should only be given to those at greater risk. The main reason for this, Dworkin says, is cost.
"A full course of treatment could cost anywhere between $100 and $160," he says. "That can add up, and insurance companies might not want to pay if the risks are very, very low."