Pain Relief: The L.A. Pain Clinic Guideby Sota Omoigui

HERPETIC NEURALGIA

The chicken-pox virus you had as a child causes Shingles. After the chicken pox has cleared, the virus hides inside your body and years later reappears as a band of angry blisters. This is more likely to happen when you get old or if your immune system is weakened by steroids, cancer treatments, AIDS or leukemia. In some people, after the blisters erupt, the virus enters the nerves resulting in bouts of constant burning knife like pain called postherpetic neuralgia. If the virus enters the eye, it may cause blindness. Postherpetic neuralgia may eventually ease on its own as the nerves heal and return to normal. Unlike chicken pox, shingles is not contagious.
Within ten days of the time your blisters first erupt, your doctor may recommend a course of oral steroids such as prednisone. The steroids may help reduce the chance of getting post herpetic neuralgia. When you have blisters, use a drying solution such as a wet compress of Domeboro powder or tablets to make them disappear. Drying the blisters may relieve the pain since the fluid inside contains pain-producing hormones known as prostaglandins. You may also apply an antibiotic cream to help prevent infections. If treated in a clinic or hospital, shingles blisters are often opened and swabbed with an antibacterial and drying lotion. Your doctor may prescribe silver sulfadiazine cream used to soothe and protect burns.
Take pain relievers, such as Aspirin or Tylenol. Your doctor may prescribe antiviral drugs such as acyclovir. If you take the antiviral medication within 24 hours of seeing blisters, you will heal faster and hurt less. A new ointment called Capsaicin (Zostrix or Zostrix HP) may also help the pain of post herpetic neuralgia by decreasing the amount of substance P, which sends pain signals to the brain. Capsaicin is the burning ingredient in red-hot chili peppers. Zostrix HP is the ‘hot’ version and Zostrix is the ‘mild’ version. Either ointment may give you a funny burning sensation that lasts the initial couple of days. Wear rubber gloves when you apply the ointment and keep it out of your eyes. Anesthetic ointment such as Lidocaine or an anti itch cream called Zonalon (Doxepin) may also be used to numb the area of pain. Anesthetic ointments such as Lidocaine or an anti itch cream called Zonalon (Doxepin) may also be used to numb the area of pain. Recently many patients have experienced significant relief from burning skin or nerve pain by applying specially compounded ointments containing Ketamine alone or various combinations of Ketamine, DMSO, Neurontin, Ketoprofen or Clonidine. Ketamine is a drug that given intravenously can produce complete anesthesia. It is not very popular as it tends to produce hallucinations. These side-effects are not seen with use of the ointment in the proper doses. Relief of pain with Ketamine ointment has been comparable or even superior to that obtained from sympathetic blocks. Other medications that help control nerve inflammation include intravenous (IV) or intramuscular steroids, IV infusion of the anti-seizure drug Depacon combined with IV infusion of magnesium sulfate and IV mini bolus doses of Ketamine. Anti-seizure oral medications e.g.Trileptal, Topamax, Lyrica or Neurontin help treat the pain. Take the medications regularly. Some of these medications may decrease the production of blood cells so your physician may have to check your blood every few weeks. Occasionally some of these medications may produce a skin rash. Other medications that are used in treating post herpetic neuralgia include antidepressants like Lexapro and strong pain relievers like hydromorphone or oxycodone. In addition to medications, nerve block with local anesthetic, steroids or glycerol may provide good long-term relief. A side effect of these procedures may be prolonged numbness in the area of pain. Before any procedure your doctor should explain the risks and benefits to you. Acupuncture, hypnosis, electrical nerve stimulation and psychotherapy are helpful in some people.

Call your Doctor: when you first see blisters and if your pain is severe or keeps you up at night.