Nerve Pain: Shingles

Overview

Shingles is a viral infection that causes a painful rash. Although shingles can occur anywhere on your body, it most often appears as a single stripe of blisters that wraps around either the left or the right side of your torso.

Shingles is caused by the varicella-zoster virus — the same virus that causes chickenpox. After you’ve had chickenpox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivate as shingles.

While it isn’t a life-threatening condition, shingles can be very painful. Vaccines can help reduce the risk of shingles, while early treatment can help shorten a shingles infection and lessen the chance of complications.

Symptoms

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

• Pain, burning, numbness or tingling
• Sensitivity to touch
• A red rash that begins a few days after the pain
• Fluid-filled blisters that break open and crust over
• Itching

Some people also experience:

• Fever
• Headache
• Sensitivity to light
• Fatigue

Pain is usually the first symptom of shingles. For some, it can be intense. Depending on the location of the pain, it can sometimes be mistaken for a symptom of problems affecting the heart, lungs or kidneys. Some people experience shingles pain without ever developing the rash.

Most commonly, the shingles rash develops as a stripe of blisters that wraps around either the left or right side of your torso. Sometimes the shingles rash occurs around one eye or on one side of the neck or face.

When to see a doctor

Contact your doctor promptly if you suspect shingles, but especially in the following situations:

• The pain and rash occur near an eye. If left untreated, this infection can lead to permanent eye damage.
• You’re 60 or older, because age significantly increases your risk of complications.
• You or someone in your family has a weakened immune system (due to cancer, medications or chronic illness).
• The rash is widespread and painful.

Causes

Shingles are caused by the varicella-zoster virus — the same virus that causes chickenpox. Anyone who’s had chickenpox may develop shingles. After you recover from chickenpox, the virus can enter your nervous system and lie dormant for years.

Eventually, it may reactivate and travel along nerve pathways to your skin — producing shingles. But, not everyone who’s had chickenpox will develop shingles.

The reason for shingles is unclear. But it may be due to lowered immunity to infections as you grow older. Shingles are more common in older adults and in people who have weakened immune systems.

Varicella-zoster is part of a group of viruses called herpes viruses, which includes the viruses that cause cold sores and genital herpes. Because of this, shingles is also known as herpes zoster. But the virus that causes chickenpox and shingles is not the same virus responsible for cold sores or genital herpes, a sexually transmitted infection.

Risk factors

Anyone who has ever had chickenpox can develop shingles. Most adults in the United States had chickenpox when they were children, before the advent of the routine childhood vaccination that now protects against chickenpox.

Factors that may increase your risk of developing shingles include:

• Being older than 50. Shingles are most common in people older than 50. The risk increases with age. Some experts estimate that half the people age 80 and older will have shingles.
• Having certain diseases. Diseases that weaken your immune systems, such as HIV/AIDS and cancer, can increase your risk of shingles.
• Undergoing cancer treatments. Radiation or chemotherapy can lower your resistance to diseases and may trigger shingles.
• Taking certain medications. Drugs designed to prevent rejection of transplanted organs can increase your risk of shingles — as can prolonged use of steroids, such as prednisone.

Complications

Complications from shingles can include:

• Postherpetic neuralgia. For some people, shingles pain continues long after the blisters have cleared. This condition is known as postherpetic neuralgia, and it occurs when damaged nerve fibers send confused and exaggerated messages of pain from your skin to your brain.
• Vision loss. Shingles in or around an eye (ophthalmic shingles) can cause painful eye infections that may result in vision loss.
• Neurological problems. Depending on which nerves are affected, shingles can cause an inflammation of the brain (encephalitis), facial paralysis, or hearing or balance problems.
• Skin infections. If shingles blisters aren’t properly treated, bacterial skin infections may develop.

Prevention

Two vaccines may help prevent shingles — the chickenpox (varicella) vaccine and the shingles (varicella-zoster) vaccine.

Chickenpox vaccine

The varicella vaccine (Varivax) has become a routine childhood immunization to prevent chickenpox. The vaccine is also recommended for adults who’ve never had chickenpox. Though the vaccine doesn’t guarantee you won’t get chickenpox or shingles, it can reduce your chances of complications and reduce the severity of the disease.

Shingles vaccine

People looking to receive the shingles vaccine have two options: Zostavax and Shingrix.

Zostavax, which was approved by the Food and Drug Administration (FDA) in 2006, has been shown to offer protection against shingles for about five years. It’s a live vaccine given as a single injection, usually in the upper arm.

Shingrix was approved by the FDA in 2017 and is the preferred alternative to Zostavax. Studies suggest Shingrix offers protection against shingles beyond five years. It’s a nonliving vaccine made of a virus component and is given in two doses, with two to six months between doses.

Shingrix is approved and recommended for people age 50 and older, including those who’ve previously received Zostavax. Zostavax isn’t recommended until age 60.

The most common side effects of either shingles vaccine are redness, pain, tenderness, swelling and itching at the injection site, and headaches.

As with the chickenpox vaccine, the shingles vaccine doesn’t guarantee you won’t get shingles. But this vaccine will likely reduce the course and severity of the disease and reduce your risk of postherpetic neuralgia.

The shingles vaccine is used only as a prevention strategy. It’s not intended to treat people who currently have the disease. Talk to your doctor about which option is right for you.