Shingles Pain Lingers After Rash Is Gone

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DEAR DR. DONOHUE: Two years ago I had shingles, and I now suffer the aftereffects of it. The sores went away in a month, but the stinging, burning, throbbing pain is still with me. I cannot wear clothing over the affected shoulder. No medicines have eased the pain so far. Is there any help? — M.L.

ANSWER: You now are dealing with postherpetic neuralgia, pain that lingers long after the shingles rash has gone. The virus that causes shingles is the same virus that causes chickenpox. Almost every adult on this continent harbors that virus, now called herpes zoster. It lives on in nerve cells.

From time to time, at older ages, it wakens from its hibernation, travels down the nerve to the skin and causes an outbreak of blisters on a red base. The outbreak goes away in about three weeks. Pain can linger for a long time — months, to years. In traveling down the nerve, the virus damaged it.

I can list some of the postherpetic neuralgia medicines. Two are antidepressants — nortriptyline and amitriptyline — given not for depression but for pain relief. Cymbalta (duloxetine) is another antidepressant that can lessen postherpetic pain. Lyrica (pregabalin) is an anti-seizure medicine that’s approved for this problem. Neurontin (gabapentin) is another seizure medicine used for control of the lingering pain of shingles.

Capsaicin lotion, cream or gel (Zostrix, Capsin, R-Gel) is applied directly to the involved skin. A higher concentration of capsaicin comes as a patch that’s applied in the doctor’s office, left on for an hour and then removed. Treatment can be repeated in three months. It’s called Qutenza. Another skin patch is the Lidoderm patch. The latest medicine is Gralise, an extended-release form of gabapentin — Neurontin. It requires fewer doses.

The entire shingles story is covered in the booklet on that topic. Readers can obtain a copy by writing: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I get my calcium by drinking milk. I believe natural sources are the best sources of vitamins and minerals. The problem is that whole milk raises my cholesterol. My father died of a heart attack at a young age. Does skim milk have as much calcium as whole milk? — R.T.

ANSWER: Skim milk contains a little more calcium than whole milk. An 8-ounce glass of whole milk has 291 mg of calcium. The same amount of skim milk has 300 mg.

DEAR DR. DONOHUE: Many months ago, my feet turned numb. The numbness has spread up to my knees. It has made me quite unsteady when I walk. My doctor can’t find a cause or treatment for this. Can you suggest anything? — L.O.

ANSWER: Your description fits peripheral neuropathy, a deterioration of nerve function, often of the leg nerves. The causes for it are many. Frequently, however, a precise cause can’t be determined. You need to make an appointment to see a neurologist as soon as you can.

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.

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