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Have Shingles. Having Pain In Upper Back, Nerve And Rashes Appeared. Should I Go For Doctor Advice?
Question: I am 58 years old and now think I may have shingles. During a heat wave of sorts, I started getting pain on the left side of my upper back, like nerve pain, then a rash appeared, very itchy and very, very painful. I thought it was from the heat. Its been about 3 weeks and the weather has cooled, but I still have the rash and a lot of pain. The rash isn't as itchy as it was, but still my back is very painful. I am even missing work on occasions because of it. Do I need to see a doctor for this?
Hi XXXXXX
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology.
I read your mail with diligence.
Your story is convincing but you will have to examined for confirming the diagnosis and starting treatment. Therefore you need to see the doctor.
In a typical patient of Shingles -Herpes Zoster viral infection the illness runs like:
As in your case: Pain is the most common complaint for which patients with herpes zoster seek medical care. The pain may be described as “burning” or “stinging” and is generally unrelenting. Although any vertebral dermatome may be involved, T5 and T6 are most commonly affected. Twenty or more lesions outside the affected dermatome reflect generalized viremia.
The vesicles eventually become hemorrhagic or turbid and crust over within seven to 10 days. As the crusts fall off, patients are generally left with scarring and pigmentary changes.
The most common chronic complication of herpes zoster is postherpetic neuralgia. Pain that persists for longer than one to three months after resolution of the rash is generally accepted as the sign of postherpetic neuralgia. Affected patients usually report constant burning, lancinating pain that may be radicular in nature. Patients may also complain of pain in response to non-noxious stimuli. Even the slightest pressure from clothing, bedsheets or wind may elicit pain.
Postherpetic neuralgia is generally a self-limited disease. Symptoms tend to abate over time. Less than one quarter of patients still experience pain at six months after the herpes zoster eruption, and fewer than one in 20 has pain at one year.
Treatment of Herpes Zoster (WHY WE WANT TO TREAT?)
The treatment of herpes zoster has three major objectives: (1) treatment of the acute viral infection, (2) treatment of the acute pain associated with herpes zoster and (3) prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
ANTIVIRAL AGENTS
Antiviral agents have been shown to decrease the duration of herpes zoster rash and the severity of pain associated with the rash.12 However, these benefits have only been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash. Antiviral agents may be beneficial as long as new lesions are actively being formed, but they are unlikely to be helpful after lesions have crusted.
The effectiveness of antiviral agents in preventing postherpetic neuralgia is more controversial. Numerous studies evaluating this issue have been conducted, but the results have been variable. Based on the findings of multiple studies, acylovir (Zovirax) therapy appears to produce a moderate reduction in the development of postherpetic neuralgia.13 Other antiviral agents, specifically valacyclovir (Valtrex) and famciclovir (Famvir), appear to be at least as effective as acyclovir.
Acyclovir, the prototype antiviral drug, is a DNA polymerase inhibitor. Acyclovir may be given orally or intravenously. Major drawbacks of orally administered acyclovir include its lower bioavailability compared with other agents and its dosing frequency (five times daily). Intravenously administered acyclovir is generally used only in patients who are severely immunocompromised or who are unable to take medications orally.
Valacyclovir, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia. Valacyclovir is also more bioavailable than acyclovir, and oral administration produces blood drug levels comparable to the intravenous administration of acyclovir.
Famciclovir is also a DNA polymerase inhibitor. The advantages of famciclovir are its dosing schedule (three times daily), its longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir.
This will give you an idea what you ought to expect and the necessity of seeing a doctor and treatment. Good Luck.
With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Thanks for writing in.
I am a medical specialist with an additional degree in cardiology.
I read your mail with diligence.
Your story is convincing but you will have to examined for confirming the diagnosis and starting treatment. Therefore you need to see the doctor.
In a typical patient of Shingles -Herpes Zoster viral infection the illness runs like:
As in your case: Pain is the most common complaint for which patients with herpes zoster seek medical care. The pain may be described as “burning” or “stinging” and is generally unrelenting. Although any vertebral dermatome may be involved, T5 and T6 are most commonly affected. Twenty or more lesions outside the affected dermatome reflect generalized viremia.
The vesicles eventually become hemorrhagic or turbid and crust over within seven to 10 days. As the crusts fall off, patients are generally left with scarring and pigmentary changes.
The most common chronic complication of herpes zoster is postherpetic neuralgia. Pain that persists for longer than one to three months after resolution of the rash is generally accepted as the sign of postherpetic neuralgia. Affected patients usually report constant burning, lancinating pain that may be radicular in nature. Patients may also complain of pain in response to non-noxious stimuli. Even the slightest pressure from clothing, bedsheets or wind may elicit pain.
Postherpetic neuralgia is generally a self-limited disease. Symptoms tend to abate over time. Less than one quarter of patients still experience pain at six months after the herpes zoster eruption, and fewer than one in 20 has pain at one year.
Treatment of Herpes Zoster (WHY WE WANT TO TREAT?)
The treatment of herpes zoster has three major objectives: (1) treatment of the acute viral infection, (2) treatment of the acute pain associated with herpes zoster and (3) prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
ANTIVIRAL AGENTS
Antiviral agents have been shown to decrease the duration of herpes zoster rash and the severity of pain associated with the rash.12 However, these benefits have only been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash. Antiviral agents may be beneficial as long as new lesions are actively being formed, but they are unlikely to be helpful after lesions have crusted.
The effectiveness of antiviral agents in preventing postherpetic neuralgia is more controversial. Numerous studies evaluating this issue have been conducted, but the results have been variable. Based on the findings of multiple studies, acylovir (Zovirax) therapy appears to produce a moderate reduction in the development of postherpetic neuralgia.13 Other antiviral agents, specifically valacyclovir (Valtrex) and famciclovir (Famvir), appear to be at least as effective as acyclovir.
Acyclovir, the prototype antiviral drug, is a DNA polymerase inhibitor. Acyclovir may be given orally or intravenously. Major drawbacks of orally administered acyclovir include its lower bioavailability compared with other agents and its dosing frequency (five times daily). Intravenously administered acyclovir is generally used only in patients who are severely immunocompromised or who are unable to take medications orally.
Valacyclovir, a prodrug of acyclovir, is administered three times daily. Compared with acyclovir, valacyclovir may be slightly better at decreasing the severity of pain associated with herpes zoster, as well as the duration of postherpetic neuralgia. Valacyclovir is also more bioavailable than acyclovir, and oral administration produces blood drug levels comparable to the intravenous administration of acyclovir.
Famciclovir is also a DNA polymerase inhibitor. The advantages of famciclovir are its dosing schedule (three times daily), its longer intracellular half-life compared with acyclovir and its better bioavailability compared with acyclovir and valacyclovir.
This will give you an idea what you ought to expect and the necessity of seeing a doctor and treatment. Good Luck.
With Best Wishes
Dr Anil Grover,
Medical Specialist & Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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