Dear Dr. Roach: Eighteen months ago, I had a case of shingles and could not access medication for three days. To this day, I experience residual problems, such as pain on the side, reduced energy level, etc. When I’ve discussed the issue with several doctors, I simply asked if some kind of treatment could be tried that would expedite or facilitate my recovery. All I get is some kind of evasive answer.
One doctor suggested that shingles are caused by a virus, and said that doctors do not have treatments for viruses. I even asked if I could take the medication that was initially prescribed at the onset of the incident. Again, no real answer. I am confused.
Do we not treat the flu, Ebola and other types of viruses? So what’s with shingles that is so different?
A.L.
It is confusing, so let me try to help. Shingles is a recurrence of the virus that causes chickenpox (varicella-zoster), which sits in the ganglia (a collection of nerve cells just outside the spinal cord) of all of us who have ever had chickenpox. It waits for the immune system to be weak enough to allow it to replicate and cause the rash of shingles.
During the time of viral replication, treatment with antiviral medications such as acyclovir, famciclovir and valacyclovir can be effective in reducing the length of pain of the outbreak and its complication, post-herpetic neuralgia.
Because these drugs work in suppressing viral growth, they are helpful only during replication, the first few days of shingles (as soon as possible, and definitely within 72 hours of onset of rash). They help protect the nerve cells from damage. Some doctors use anti-inflammatories such as prednisone, but recent studies suggest little or no benefit in people taking acyclovir.
What’s different about shingles is the potential for post-herpetic neuralgia — the pain caused by damage to the nerves, which persists months and even years after shingles. There are treatments for post-herpetic neuralgia, such as gabapentin and amitriptyline, but these act on the damaged nerve and its impulses, not on the virus. The virus is long gone, having already done its damage. Neither antiviral medicine nor a vaccine can help at that point. That’s why prevention is best (shingles vaccine) and early treatment is critical (even in people who had the vaccine, since the shingles vaccine isn’t perfect).
We do have antiviral medicines for more and more viruses now, especially the herpes viruses (such as varicella-zoster and HSV), but also flu, HIV, hepatitis B and C, and an experimental treatment for Ebola.
We do not have effective antiviral treatment for the viruses that cause colds, such as the corona and rhinoviruses.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
