Many treatments available for shingles pain

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DEAR DR. DONOHUE: In January, I came down with shingles. The shingles cleared up, but I continue to have pain. My body feels like I’m living in a torture chamber. Help! When I was 28, I had chickenpox. Now, 49 years later, I have this. – R.K.

ANSWER: Shingles is the resurrected chickenpox virus that lives on in nerve cells after infecting people, usually in childhood. In later life, when immune defenses have a momentary lapse, the virus crawls out of the nerve cell, travels down the nerve to the skin and produces the typical shingles rash and pain.

A shingles outbreak is bad. The pain that often lingers long after the rash is gone is worse. That’s postherpetic neuralgia, and it comes from damage done to nerves as the virus crawled down them to the skin.

To combat postherpetic neuralgia, a person’s first step should be a pain-reliever that’s not a narcotic. Some find that Tylenol works. Advil, Aleve, Motrin, Naprosyn and the many related medicines are other reliable pain-relievers.

The next step is a trial of medicines put directly on the painful skin. Lidoderm is an adhesive skin patch that contains the numbing agent lidocaine. Capsaicin cream is another skin-applied anti-pain preparation.

If the pain refuses to budge, then Neurontin, a medicine whose primary use is seizure control, can often take it away. So might amitriptyline, an antidepressant with pain-numbing properties.

The newest medicine for postherpetic pain is Lyrica. Narcotic pain medicines can be used when these fail – oxycodone, for example.

When the medicine route falters, nerve blocks can be tried.

A vaccine is on the verge of making its appearance on the market. It is hoped that it will greatly lessen or even put an end to shingles and postherpetic neuralgia.

The shingles booklet explains this common problem in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a blind friend who needs your help. She is 82. She’s 5 feet 3 inches tall and weighs 108 pounds. The blood circulation in her legs is very poor. They told her she has vascular disease. What can she do to improve her situation? – H.B.

ANSWER: Your friend has a very common condition, a blockage of her leg arteries by blobs of cholesterol, fat and platelets clinging to their walls.

She is thin, so it’s not obesity that’s contributing to the problem. If she has high blood pressure, that has to be normalized. If her cholesterol is out of whack, that should be addressed by a low-fat, low-cholesterol diet and possible cholesterol medicines.

You can help her out by taking her on a daily walk. Walk until she says her legs hurt, and then rest until the pain goes. Then walk again. Start slowly. A five-minute session would be enough at first. Gradually lengthen the walk time until she can handle a full half an hour. You can break the walks into three 10-minute periods. Make sure that her doctor says exercise is OK for her.

DEAR DR. DONOHUE: Six years ago I was in the hospital with a blood clot. The doctor put me on Coumadin. This is not a blood thinner. In some of your columns, you say Coumadin does not thin the blood. In others you tell of its blood-thinning properties. Does it or does it not thin the blood? It would be easier to understand if you were consistent. – E.

ANSWER: In everyday speech, “blood thinners” refer to anticoagulants, medicines that stop clot formation. They do not thin the blood. They don’t make it watery. Coumadin, heparin and aspirin are not blood thinners but are anticoagulants.

I use blood thinner only because most people use that expression, and most understand that it means “anticoagulant.” I’ll be 100 percent consistent and use it all the time, with an explanation given when I do.

DEAR DR. DONOHUE: I am curious why you did not recommend melatonin to the letter writer who was bothered by sleeplessness. It is naturally made by the body as a sleep hormone. My son-in-law is about to be a nurse practitioner, and he recommended it to me two years ago. It has been very effective for me. – G.G.

ANSWER: The pineal gland, an enigmatic gland attached to the brain, makes melatonin, a hormone involved in the regulation of sleep cycles. There is a decline in its production with age, and some feel that’s why older people are so often troubled with insomnia. I’m just waiting for the final word on its effectiveness. I’m a fan of Alexander Pope, who wrote: “Be not the first by whom the new are tried, nor yet the last to lay the old aside.”

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible.

Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com

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