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Prevent the 'Crazy' Pain of Shingles

The childhood chicken-pox virus may make a
 nasty comeback years later. But a vaccine can help protect you

Retired teacher Valerie Harmon, 70, is no wimp. “I’m good with pain,” she says. “But this was crazy.”

On a night in January 2011 that she’ll never forget, the Hastings-on-Hudson resident, a widow, woke up with incredible pain searing her lower back. Her doctor, Carol Karmen, M.D., a general internal medicine specialist with Westchester Medical Center, diagnosed shingles.

Shingles, which affects an estimated
 one million people in the United States each year, is a disease caused by the varicella-zoster virus, the same one that produces chicken pox. After you have chicken pox, the virus stays dormant in your body. It may not cause problems for decades—and may never do so. But in some people, mostly those age 50 and older, the virus may reappear as shingles.

Early signs of shingles include burning or shooting pain and tingling or itching, usually on one side of the body or face. The pain can be mild to severe. Blisters then form and last from one to 14 days.

Anyone who has had chicken pox can develop shingles, but those 
with weakened immune systems are particularly vulnerable. Shingles is contagious to anyone who has never had chicken pox.

There is no cure for shingles, but
 Dr. Karmen says sufferers can be treated with one of three antiviral drugs: acyclovir, valacyclovir or famciclovir. “These drugs can shorten the duration of the rash, which typically takes seven to 10 days to subside, and may reduce or prevent the pain,” says the doctor, who also recommends pain medications to treat what she describes as “severe, burning, throbbing” pain.

The Centers for Disease Control and Prevention says that among those who get shingles, more than one-third will develop serious complications, with the risk of complications rising with age. If shingles appears on the face, it can lead to problems with hearing and vision. For instance, if shingles affects the eye, the cornea can become infected, leading to temporary or even, possibly, permanent blindness.

Another complication of the virus is post-herpetic neuralgia (PHN), a condition in which the pain from shingles lasts for months—or even years—after the shingles rash has healed. Antiviral medicines may help stave off the painful after effects of PHN.

Clearly, the best thing you can do about shingles is to try to avoid it. Dr. Karmen recommends that almost everyone over age 60 get the shingles vaccine, even those who have already had a case of shingles. Though it’s not perfect, the vaccine can reduce the chances of contracting shingles by 
50 to 70 percent, she says. Health experts estimate that the vaccine could prevent 250,000 cases of shingles in the United States each year and significantly reduce the severity of another 250,000.

Harmon says her antiviral treatment, in the form of one pill a day, slowly decreased her pain—though she required medication to help her sleep for the first several days. After about a week, she took the treatments only
 as needed for another week or two, and once her sores healed she was pain-free.

She has also had the shingles vaccine to protect against a recurrence. “I wouldn’t want to go through that again!” she says.



Carol Karmen, M.D., a general internal medicine specialist at Westchester Medical Center, answers questions about the shingles vaccine, Zostavax®:

What makes the Vaccine work? “It contains a weakened version of the varicella-zoster, or chicken-pox, virus, that triggers your immune system to help lower your risk.”

How is it given? “In one dose by an injection under the skin, usually on the upper arm.”

Is It 100-percent effective? “No. In a clinical trial involving about 20,000 older adults, reports the Centers for Disease Control and Prevention [CDC], the shots reduced the risk of shingles by 51 percent and the risk of post-herpetic neuralgia by 67 percent.”

Who should receive the vaccine? “The CDC has recommended a vaccination for most individuals age 60 and older. The Food and Drug Administration has also approved the vaccine for ages 50 through 59, but for this age group the CDC hasn’t made a recommendation.”

Who should not receive the vaccine? “Pregnant women or those who might be or are trying to become pregnant; transplant patients; people with weakened immune systems due to HIV/AIDS, steroids, cancer or cancer treatments; and those who have ever had a severe allergic reaction to gelatin or the antibiotic neomycin. Tell your doctor about any severe allergies.”

What are the vaccine’s most common side effects? “Redness, soreness, swelling or itching at the injection site, and headache.”

Do health insurance plans cover the shingles vaccine? “Some do, some don’t. Medicare Part D plans cover it, at a variable cost to the patient, but Medicare Part B does not. And it’s the most expensive vaccine that is routinely recommended. So check your coverage carefully.”

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