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Suggest Treatment For Trigeminal Neuralgia Post Shingles Infection
Question: I am 64 years old. Had severe case of chicken pox as a child (worse on head and face). Month and a half ago I started with a small 1/2" red spot on my eyelid for two weeks (thought it may be a ingrown eyebrow hair). Then suddenly my eye lid became swollen shut with high level of pain and extreme itching/burning of my scalp within two days. Went to ER (due to it being Christmas Day); was immediately hospitalized; was given heavy doses of antibiotics intravenously (Cephalexin, Clidamaycin), wasn't until the 3rd day they realized I had shingles so then was give medication (Valacyclovir) for that.
Now home (1 month later); on just Gabapentin 300 mg every 8 hrs (with 600 mg at the before bed dose). Care instructions now are for Trigeminal Neuralgia after shingles.
Experiencing fair amount of discomfort during the day time; sleeping longer periods at night (with the Dr. recommended 600 mg dose) waking with shorter periods of pain.
Currently experiencing painful touch to head and forehead, some burning sensation and sharp pain to temple and neck area. Forgetting what I want to say at times or words; feel like my head/scalp is tight with burning sensation; light headed & slightly dizzy at times.
1. How long does it take for the medicine to work?
2. Do you became immune to a dose after a while?
3. Should my symptoms subside after a while.
4. Does Gabapentin mask the pain or eventually stop the pain so you won't need it any more?
5. What are my chances of getting shingles again now and would it most likely be in the same location?
Sorry for so many questions; but I'm in a situation recently without proper money for care; out of work due to recent (2 month ago) bankruptcy with our 25 yr business. Any advise would be so appreciated as I am normally a very happy person; active and a high performing individual.
Now home (1 month later); on just Gabapentin 300 mg every 8 hrs (with 600 mg at the before bed dose). Care instructions now are for Trigeminal Neuralgia after shingles.
Experiencing fair amount of discomfort during the day time; sleeping longer periods at night (with the Dr. recommended 600 mg dose) waking with shorter periods of pain.
Currently experiencing painful touch to head and forehead, some burning sensation and sharp pain to temple and neck area. Forgetting what I want to say at times or words; feel like my head/scalp is tight with burning sensation; light headed & slightly dizzy at times.
1. How long does it take for the medicine to work?
2. Do you became immune to a dose after a while?
3. Should my symptoms subside after a while.
4. Does Gabapentin mask the pain or eventually stop the pain so you won't need it any more?
5. What are my chances of getting shingles again now and would it most likely be in the same location?
Sorry for so many questions; but I'm in a situation recently without proper money for care; out of work due to recent (2 month ago) bankruptcy with our 25 yr business. Any advise would be so appreciated as I am normally a very happy person; active and a high performing individual.
Brief Answer:
Read below
Detailed Answer:
I read your query and I understand your concern, post-herpetic neuralgia can be a very bothersome complication of Herpes Zoster (shingles). It is a frequent complication chances of which increase with age.
Regarding your questions:
1. Gabapentine should be working by now, you are taking a considerable dose.
2. No, it does not develop tolerance, doesn't lose its effect like some other drugs.
3. Generally with time symptoms subside, in terms of percentages while it is present in around 13% after one month, that figure drops to 5% after 3 months and even lower later. However there is a 3% of patients who still experience pain after the first year and can be troubled for a long time. That is a very low percentage though, so hopefully you won't be among these unlucky few.
4. Gabapentine masks the pain it does not remove the origin, it will be a natural healing process of your body.
5. Chances of recurrence are low, numbers from studies vary from 1-5% in individuals with normal immune system. If one has a disease or is taking a drug compromising the immune system then those chances are higher.
As for the location of recurrences, more often it is in the same site, but other sites can be involved (around 45% of cases different site).
As for other advice, Gabapentine is a good choice to start with. If it is not working for you though another good alternative are tricyclic antidepressant drugs like Amitriptyline or Nortriptyline.
Wishing you a speedy recovery!
Read below
Detailed Answer:
I read your query and I understand your concern, post-herpetic neuralgia can be a very bothersome complication of Herpes Zoster (shingles). It is a frequent complication chances of which increase with age.
Regarding your questions:
1. Gabapentine should be working by now, you are taking a considerable dose.
2. No, it does not develop tolerance, doesn't lose its effect like some other drugs.
3. Generally with time symptoms subside, in terms of percentages while it is present in around 13% after one month, that figure drops to 5% after 3 months and even lower later. However there is a 3% of patients who still experience pain after the first year and can be troubled for a long time. That is a very low percentage though, so hopefully you won't be among these unlucky few.
4. Gabapentine masks the pain it does not remove the origin, it will be a natural healing process of your body.
5. Chances of recurrence are low, numbers from studies vary from 1-5% in individuals with normal immune system. If one has a disease or is taking a drug compromising the immune system then those chances are higher.
As for the location of recurrences, more often it is in the same site, but other sites can be involved (around 45% of cases different site).
As for other advice, Gabapentine is a good choice to start with. If it is not working for you though another good alternative are tricyclic antidepressant drugs like Amitriptyline or Nortriptyline.
Wishing you a speedy recovery!
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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