Shingles, also known as herpes zoster, is a painful skin condition that can be managed in a number of different ways. During the acute infection, while patients have skin lesions and pain associated with those visible sores, pain can be controlled with lotions and analgesic medications. Some patients develop a chronic pain syndrome called post-herpetic neuralgia after the acute infection, and this syndrome can last for months or years.
In the acute phase of the disease, pain management for shingles focuses on alleviating symptoms and treating the underlying disease. Taking antiviral medications such as acyclovir can decrease the duration of the pain by eradicating the cause of the symptoms. Lotions, such as calamine lotion, can soothe skin that has been irritated by the rash characteristically associated with shingles. Many physicians advise patients to take oral pain medications, including acetaminophen or narcotics, to help cope with the pain.
The pain management for shingles after the initial acute skin breakout is often more complicated, since this pain is harder to eradicate. During the post-herpetic neuralgia stage that some patients reach, relief can be obtained by ointments and different classes of oral medications. Helpful ointments include those with capsaicin, a substance derived from hot peppers, and salves containing aspirin. Often these topical treatments must be applied a number of times a day to achieve the maximum benefit.
Another option in the pain management for shingles is to give medications that were initially developed to prevent seizures. These anti-epileptic medications decrease the activity present in the nerves, and therefore deaden some of the pain associated with post-herpetic neuralgia. Examples of these medications include gabapentin, valproic acid, and carbamazepine. Often the specific drug chosen for a particular patient depends on the types of side effects associated with the medication.
Medications in the antidepressant family of drugs can also be good options for pain management for shingles after the acute skin lesions resolve. Tricyclic antidepressants in particular tend to decrease the pain felt by patients. Occasionally, medications classified as selective serotonin reuptake inhibitors (SSRIs) can be given to patients, but their use is less prevalent.
Some doctors advocate the use of surgery in pain management for shingles. Since the pain is transmitted by peripheral nerves, the general idea is that the deadening of these nerves could lead to decreased pain. Procedures including injections of anesthetic material into the location where the nerve begins have been used with some success. Typically, however, the pain is managed more effectively with oral medications compared to surgical interventions.