Pain Related to "Shingles" Revisited

The following are some useful references on pain related to Herpes Zoster (Shingles) and Postherpetic Neuralgia:

1) Does sympathetic ganglionic block prevent postherpetic neuralgia?

2) Acute Herpes Zoster and Postherpetic Neuralgia

3) Primary care treatment for postherpetic neuralgia in acute herpes zoster

4) A Review Of Postherpetic Neuralgia

Prevention of Herpes Zoster [Shingles]

In a previous post, we talked about a dreadful disease--"Herpes Zoster" or "Shingles"--that can lead to severe and intractable pain, particularly in the elderly population. In order to refresh your memory, it might help if you refer to the post, linked here.

Vaccination against this condition is now being promoted as an important preventive measure. The article below will shed some light on the question of vaccination and its value for the aging population.

Who should receive zoster vaccine?

In this review, the authors consider the nature of herpes zoster and the preventive value of the herpes zoster vaccine. Herpes zoster will occur in approximately one third of the population during a lifetime. Because immunity conferred by the childhood varicella vaccination wanes over time, reactivation of the virus in older adults becomes increasingly likely with increasing age. Half of those aged 85 will experience at least one zoster outbreak. Postherpetic neuralgia is one troublesome complication of this condition, particularly in the elderly.

Can herpes zoster be prevented? In a large efficacy study, more than 38,000 subjects were randomized to receive live attenuated zoster vaccine or placebo (see Journal Watch Dermatology Jun 14 2005). Compared with placebo recipients, vaccine recipients had a 51% lower incidence of herpes zoster, and less frequent, less painful, and shorter-course postherpetic neuralgia.

The authors, therefore, recommend a single dose of vaccine for everyone over the age of 60, barring contraindications, to decrease the incidence of zoster and postherpetic neuralgia. Whether to vaccinate immunocompromised persons is an open issue that is important to resolve because of increased risk for herpes zoster in this population.

— Lowell A. Goldsmith, MD, MPH

Published in Journal Watch Dermatology March 30, 2007

Citations:
Kimberlin DW and Whitley RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med 2007 Mar 29; 356:1338-43. [PubMed® abstract]

Copyright © 2007. Massachusetts Medical Society. All rights reserved.

The above message comes from "Journal Watch", who is solely responsible for its content.

Acute & Chronic Pain

Question:

What are the main differences between acute and chronic pain?

Answer:

Acute pain, even though is not a pleasant sensation, serves a useful function. Without the sensation of pain we could easily injure or burn ourselves without knowing it. Another example: if we do not feel the pain caused by a disease condition, such as acute appendicitis, we would not know that we suffer from a serious medical condition and neglect to seek medical help; so in this case pain acts as a warning signal telling us that something is wrong with our body. Acute pain is usually associated with other signs of increased sympathetic nervous system activity, such as increase in blood pressure, rise in heart rate, sweating, pallor, anxiety, fear and restlessness.

On the other hand, chronic pain is the sensation of pain that continues after the complete healing of the initial cause of pain and might last for months, weeks or years. It no longer serves a useful function, and becomes a disease on its own. It is not associated with rise in blood pressure or heart rate, but is rather accompanied with significant changes in personality and behavior. It leads to depression, anxiety and anger. In some cases it can be accompanied with manifestations of hypochondriasis and hysteria as well as certain personality disorders. it leads to employment difficulties, job loss, socio-economic consequences, drug dependence and abuse, as well as family difficulties and divorce. In severe and intractable cases, it can even lead to suicide.

One of the examples of chronic pain conditions is shingles (herpes zoster), an extremely painful condition caused by the reactivation of a dormant varicella-zoster virus which infects young people--mostly children--causing the disease known as chickenpox. After the resolution of this disease, the virus becomes dormant (goes to sleep) and remains in the body hidden in the brain and the spinal cord in certain nerve tissue relay structures called ganglia.

Later on in life the virus can reactivate as a result of a variety of factors, such as decreased immunity, cancer, HIV infection, trauma to the nervous system, toxic exposure, severe illness and many other conditions. When the virus reactivates (wakes up) it spreads along the individual nerves connected to these ganglia. causing severe nerve pain and rash. The older the person the more likelihood of continuation of pain after the complete healing of the rash, which is the result of permanent nerve damage.

This is a perfect example of differences between acute and chronic pain and it illustrates how an acute condition could turn into a chronic disease.