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Doctors' Answers to "Frequently Asked Questions" - Shingles

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 10/20/1999]

Answer: Nothing except residual pain where the shingles were. If there is no pain in the distribution of the previous shingles, you're home free.

Zostrik for Shingles [posted 10/20/98]
Question: What do you know of zostrik? It is supposed to work wonders on the pain caused by shingles. My 84 year old mother suffers from pains in her legs that are caused by "shingles" and old age according to her doctor. She has no blisters. The pain must be extreme, her face becomes white when it sets in. The doctor told her to take aspirin or other analgesics. She can swallow just so many of those. I heard that zostrik works wonders for shingles. Would it be safe for me to rub her legs with that ointment?

Answer: Usually pretty effective. Start with the .025% cream and use it once a day. Advance to twice a day after a week. If she tolerates this ok(burning locally the major problem) advance to the .075%. It takes 3-4 weeks to work and is made from peppers so avoid contact with sensitive parts of the body and ensure you wash you hands before rubbing your eyes, etc.

Question: My father-in-law has suffered with the shingles for many years. He has found nothing to alleviate the pain. It is on the right side of his face and in his eye. He heard recently on TV that there is an experimental drug for epilepsy right now that may also be used to treat shingles. Do you know anything about this? Can you refer us to a specialist? We live in N.C.

Answer: You don't need a specialist for this. Has he tried Caspian cream? This is available over the counter and works about 75% of the time. Apply it twice a day to the affected areas(it is made of hot peppers so avoid the eye and nasal linings). It will take 4-6 weeks to work. If this does not work, different drugs for chronic pain may help. Depakote is one as is dilantin-- both seizure medications.

Question: My neighbor is 78 and has shingles for over 1 month. His doctor has treated him with B vitamins. He still has pain and the shingles have dried up. He continues to have a loss of appetite. His doctor does not want to use cortisone. What do you recommend?

Answer: Shingles is a breakout of latent Herpes Simplex (chicken pox). The virus once in your body will "hide" in the spinal cord. Then during times of stress, immune suppression, or for random reasons it will break out again. During this second infection the virus only travels along the nerve or nerves in the spinal cord where it is "living". This gives a characteristic band effect which almost never effects both sides of the body at the same time. The characteristic vessicles appear as little blisters. These last for about 7-10 days and then dry up and crust over. While one has active blisters,the virus is contagious to those people or pregnant women who have not had chicken pox. After the blisters dry up and fall off there tends to be a characteristic neuropathy. About 30-75% of patients will continue to experience pain in the area of the viral infection and blisters. Treatment during the actute phase with anti-viral drugs appears to have some effect in decreasing the incidence of post-herpetic neuralgia which is the medical name for this pain syndrome. Treatment with Zostrix(capsaicin) over three to four weeks can be very effective. This drug is derived from a type of hot pepper and appears to work by working on the local nerve fibers which cause the pain. Recently, this drug has recieved a lot of use in diabetic neuropathy, arthritis and many other chronic pain syndromes.

Side Effects from Hydroco/Apap
Question: My mother is taking Verapamil and developed shingles and is now adding hydroco/apap and amitriptyline to treat shingles. Are there any side effects?

Answer: Hydroco/apap is medical short hand for hydrocodone plus acetaminophen-the side effects for this combination usually centers on the hydrocodone. Hydrocodone is a narcotic and as such has the same side effects as most narcotics;that is, constipation, nausea(especially if on an empty stomach) vertigo and difficulty concentrating. Amitriptyline was originally used as an anti-depressant. However, it is limited by its anticholinergic side effects. That is, constipation, drowsiness, dry mouth and occasionally difficulty focusing. These same anti-cholinergic side effects are what potentiate any analgesia. That is, an antihistamine or any drug with anticholingeric side effects will increase the effect of other pain medicines. Verapamil is a calcium channel blocker used for angina, hypertension and occasionally irregular heart beats. It has the side effect of constipation and swollen feet. As a consequence, your mother is likely to have severe constipation on this regimen.

Strange Symptoms
Question: My fathers contracted shingles in July this summer. After three weeks he started improving. Suddenly on an afternoon he became very ill, shivering and sweating. He was taken to hospital where doctors said there was nothing wrong with his heart and this could all be as the result of shingles. He then lost his hearing in one ear. He has lost much of his strength. I would be grateful if you would advise me of any drugs that could be used for improving his hearing and improving his strength.

Answer: There probably is no drug that will help his hearing. I doubt that the shingles would be responsible for the problem three weeks into the infection. I'd look for another source of the problem.

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