Her moans extend into the hallway. She was curled up on the exam table, crying out that she would rather die than spend another day like this. Her silvery gray hair reminded me of my grandmother. Her daughter stood beside her looking at me anxiously. My heart went out to them both. “Excruciating pain to the right chest wall, hypersensitive with a rash to the same area. She cannot bear to wear her bra due to the severe pain when anything touches her skin.” Shingles! The chicken pox virus from childhood coming back to play. It has been living in her nerve roots since she had chicken pox as a kid. Sometimes triggered by stress or suppression of the immune system, this is one of the most painful conditions we can suffer as humans.
Her primary care had prescribed anti-viral medication and Vicodin, but her pain did not respond to this. Nerve pain from various causes often does not respond to typical pain pills such as Vicodin. I discussed this with them and suggested initiating seizure medication. This class of medications is effective through suppression of some of the electrical hyper firing of nerve fibers. We scheduled her urgently for an epidural injection with numbing medication. As I had seen before, this injection lowered her pain by 50%. She was so thankful. I could see the peaceful relief come across her face as the medication soaked into the nerves. We repeated the injections a couple more times over the next few weeks, with incremental improvement that was sustained.
At the last appointment, she had driven herself. She wanted to stop the seizure medications due to minimal residual pain. I encouraged her to continue for the next few months, as this medication can keep those nerves suppressed that have been damaged by the virus. There is inadequate information to be certain, but anti-viral and seizure medications and these injections may help prevent a long lasting condition after shingles called Post-Herpetic Neuralgia. This condition has similar excruciating pain as shingles. The rash will have faded long ago, but the pain is severe. Most recently, there is a vaccine that helps prevent shingles. Please consult your physician about this vaccine. Early treatment with the other measures described is best once shingles occurs. The location for numbing medication injection varies depending on the site of the rash, and is typically delivered by a specialty trained physician with x-ray guidance.
Ed McCluskey, MD
Pain Relief Specialists Northwest
