Opioids May Be Good for Shingles Pain

Study Finds Few Side Effects With Controversial Treatment

Oct. 8, 2002 -- Morphine and other powerful, opiate-based pain medications may be a safe bet for treating shingles-related pain in elderly patients. A new study shows that the drugs can work just as well or even better than current therapies without dangerous side effects.

Researchers say doctors have been reluctant to prescribe the potent painkillers to elderly shingles patients because they were fearful the patients might become dependent on the drugs or suffer mental disturbances.

But after testing the drugs in 76 senior citizens with shingles, researchers found opioids provided effective pain relief without these side effects. Their study appears in the Oct. 8 issue of Neurology.

Shingles are caused by the same herpes zoster virus that causes chicken pox; they occur when the virus is reactivated in a person who has already had chicken pox. The condition causes painful, burning rashes on the skin that resemble a band or belt. After the rashes heal, some people suffer extreme sensitivity to cold, heat, or touch in the area of the rash.

Currently, many older shingles patients are prescribed antidepressants to relieve this post-rash pain, but researchers say the treatment fails to provide at least moderate relief in about half of the patients and can have significant side effects.

In this study, researchers compared the effectiveness of an opioid with an antidepressant or placebo in 76 shingles patients, whose average age was 71. Each of the participants took one of the three therapies for eight weeks.

Although some patients dropped out of the study due to negative side effects or family concerns about opiates, by the end of the study more patients said they preferred the opiate treatment (54%) to the antidepressant (30%).

Forty-four of the 76 patients completed all three parts of the study, and 38% reported pain relief from the opioids, compared with 32% who had relief from antidepressants and 11% with the placebo.

The study failed to show differences in mental skills in the different treatment groups. There were no differences in concentration, verbal learning, manual dexterity or speed when the patients took opioids, antidepressants, or placebo.

"By comparing opiates to antidepressants head to head, our study suggests that opiates effectively relieve pain and are preferred by a greater proportion of patients," says researcher Srinivasa N. Raja, MD, director of pain research at Johns Hopkins Medical Institutions, in a news release. "This adds further evidence that opiates are a good alternative for patients not responding to other types of pain medications."

Although the study showed opioids tended to work better with few side effects, the authors say it's still too soon to recommend that opioids become the first choice in treating shingles-related pain. They say more long-term studies are needed to look at the risks and benefits of using opioids versus other, currently available treatments.

The risk of developing shingles increases with age and if a person has another condition that weakens the immune system.