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Does Shingles Cause Insomnia

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Shingles: Postherpetic Neuralgia’s Stubborn Mother

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PHN is triggered by shingles which is triggered by chicken pox. Some think of shingles as adult chicken pox and while it’s true both shingles and chicken pox are caused by varicella-zoster virusa common infection of the nervesthat’s pretty much where the similarity ends.

If you had chicken pox as a kid the varicella-zoster virus has been residing in your body ever since. It didn’t leave when your chicken pox resolved. Instead, it took up residence and remained a low-maintenance tenant until either age, a weakened immune system, stress, or some sort of cruel combination transformed the varicella-zoster virus into the herpes virus causing shinglesa much more demanding occupant.

Shingles typically starts with a variety of sensationsburning, tingling, and itching. Within days a blistery rash appears, usually on one side of the body typically around the torso, and the sensations may get more severe and painful. Within weeks the rash disappears and with it, those sensations.

Treatment Of Postherpetic Neuralgia

Apply to affected area every 4 to 12 hours as needed.

Tricyclic antidepressants

Amitriptyline

10 to 25 mg orally at bedtime increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 150 mg per day.

Nortriptyline

10 to 25 mg orally at bedtime increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 125 mg per day.

Imipramine

25 mg orally at bedtime increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 150 mg per day.

Desipramine

25 mg orally at bedtime increase dosage by 25 mg every 2 to 4 weeks until response is adequate, or to maximum dosage of 150 mg per day.

Anticonvulsants

Phenytoin

100 to 300 mg orally at bedtime increase dosage until response is adequate or blood drug level is 10 to 20 g per mL .

Carbamazepine

100 mg orally at bedtime increase dosage by 100 mg every 3 days until dosage is 200 mg three times daily, response is adequate or blood drug level is 6 to12 g per mL .

Gabapentin

100 to 300 mg orally at bedtime increase dosage by 100 to 300 mg every 3 days until dosage is 300 to 900 mg three times daily or response is adequate.

*Additional modalities include transcutaneous electric nerve stimulation , biofeedback and nerve blocks.

How Postherpetic Neuralgia Is Treated

Many effective treatments are used to treat PHN, including medications, physical therapy, exercise, and a range of alternative therapies. There is no one approach to treatment that will work for everyone. A combination of treatments often is needed to reduce pain.

Medications

Your doctor may first recommend drugs you can get at the drugstore without a prescription, such as acetaminophen , or non-steroidal anti-inflammatory drugs . Capsaicin creammade from hot chili pepper seedsis also something you may want to try. When applied to the affected skin it may help reduce PHN-related pain. All of these treatments may cause side effects, including the capsaicin cream, so it is important to talk to your doctor about the correct way of using them.

If these medications arent strong enough to treat your PHN symptoms, your doctor may suggest some of the following prescription medications:

  • Tricyclic antidepressants: These include drugs such as amitriptyline , nortriptyline , and desipramine these drugs take a few weeks to start working.
  • Anticonvulsants: These drugs include gabapentin , carbamazepine , and pregabalin .
  • Antivirals: These drugs include valacyclovir and acyclovir.
  • Lidocaine patches: Placed on your skin, the lidocaine in the patches penetrate your skin and go to the nerves sending the pain signals.
  • Capsaicin patches : These prescription patches contain very high concentrations of capsaicin and is applied in the doctors office for one hour every three months.

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Treatment If The Condition Gets Worse

In some cases, shingles causes long-term complications. Treatment depends on the specific complication.

  • Post-herpetic neuralgia is persistent pain that lasts months or even years after the shingles rash heals. Certain medicines, such as anticonvulsants, antidepressants, and opioids, can relieve pain. Most cases of PHN resolve within a year.
  • Disseminated zoster is a blistery rash over a large portion of the body. It may affect the heart, lungs, liver, pancreas, joints, and intestinal tract. Treatment may include both antiviral medicines to prevent the virus from multiplying and antibiotics to stop infection.
  • Herpes zoster ophthalmicus is a rash on the forehead, cheek, nose, and around one eye, which could threaten your sight. You should seek prompt treatment from an ophthalmologist for this condition. Treatment may include rest, cool compresses, and antiviral medicines.
  • If the shingles virus affects the nerves originating in the brain , serious complications involving the face, eyes, nose, and brain can occur. Treatment depends on the nature and location of the complication.

What Research Is Being Done

Therapeutic Touch and the Pain that is Shingles

The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health, the leading supporter of biomedical research in the world.

The NINDS funds and conducts research on a wide range of neurological disorders, such as shingles, to understand their causes and to develop and improve ways to diagnosis, treat, and prevent them.

Medical research on shingles has two main goals. The first is to develop drugs to fight the disease and to prevent or treat its complications. The second is to understand the disease well enough to prevent it, especially in people at high risk. To achieve these goals, scientists need to learn much more about VZV and its effects, including how it becomes latent in nerve cells , what induces it to become active again, and how such reactivation can lead to postherpetic neuralgia and other complications..

Research on postherpetic neuralgia includes studies in animal models of the condition, to better understand cellular changes that lead to persistent pain. These changes may represent future targets in the form of improved vaccines, new medicines, or even gene therapy.

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Treatment Of Herpes Zoster

The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.

Comparison Of Demographics And Comorbidity Between Sleep Disorder Patients And Controls

The mean follow-up years of the patients with sleep disorders and the comparison cohort were 7.28±1.61 and 7.41±1.52 years, respectively . Because of sex and age matching, these demographic characteristics did not differ between the 2 cohorts. The 64,548 sleep disorder patients and 66,453 controls without sleep disorders had a mean age of 51.2±16.5 years and most were women . Compared with the controls, the patients with a sleep disorder had a higher proportion of medical comorbidities, namely DM , cancer , and autoimmune diseases . We did not further analyze the HIV/AIDS cases because they were limited in frequency .

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What Does Shingles Look Like

My shingles rash looked like someone had put a cigarette out on my eyelid. Frankly, I bet that would be less painful.

You would have thought by now I would’ve caught on … but I never really realized that young people can get shingles. It just never crossed my mind. If I had simply done an internet search of my symptoms, it would’ve been obvious what I had.

According to Healthline:

“You may begin to notice pink or red blotchy patches on one side of your body. These patches cluster along nerve pathways… The rash quickly develops fluid-filled blisters similar to chickenpox. They may be accompanied by itching. New blisters continue to develop for several days. Blisters appear over a localized area and do not spread over your whole body.”

Shingles also commonly has a rash that wraps around half of your waist, which people sometimes call the “shingles belt” or “shingles girdle”. Lovely. I’d never heard of that, but I am also not over 70, and I assume these terms are more popular in that age bracket.

Developing shingles on your face, like I did, is common. It’s also common to get them on your neck and torso though there are lots of other possibilities. And no matter where they look truly ugly and disgusting. More importantly, those blisters hurt. It’s deep down nerve pain.

Here’s what my shingles looked like around my eye :

So I didn’t catch all those initial symptoms of shingles, but my doctor did.

“Yeah, you’ve got shingles,” my doctor told me.

What Else To Expect With Postherpetic Neuralgia

Moderna COVID-19 vaccine causes painful side effects in patients who have facial fillers | ABC7

Not everyone with PHN will experience the same type of pain symptoms.Researchers found that patients with PHN report three major types of pain:

  • Constant pain described as burning, aching, or throbbing
  • Intermittent pain described as stabbing, shooting, or like electric shocks
  • Pain triggered by but disproportionate to a stimulus 5
  • The length of time PHN lasts also varies. Many patients report symptoms lasting from one to three months, but some patints may experience symptoms up to a year or longer.6

    Because you may have to live with a certain degree of pain and discomfort for many weeks or months if you have PHN, expect some effect on your daily living.

    • Physical impacts: may include fatigue, weight loss, reduced mobility, physical inactivity, and insomnia.
    • Psychological impacts: may include anxiety, emotional distress, depression, difficulty concentrating, and fear.
    • Social impacts: may include withdrawing from social engagement, isolation, attending fewer social gatherings, loss of independence, change in social role.
    • Functional impact: may include difficulty with daily tasks such as dressing, bathing, and eating, as well as activities such as cooking, shopping, and travelling.7

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    Long Term Side Effects

    In rare cases, the live shingles vaccine, Zostavax, can cause a skin rash or shingles.

    The rash that occurs with shingles can affect any area of the body, but it often appears as a line of blisters that wraps around the torso.

    Within a few days the blisters cluster, and they continue to form for several more days. The blisters can take 2â3 weeks to heal, according to the American Academy of Dermatology.

    Other common symptoms of shingles include:

    • headache

    two shingles vaccines for adults: the recombinant zoster vaccine and the zoster virus vaccine .

    Why Your Mental Health Matters

    Living with chronic pain is not easy. Not knowing how long the pain will persist is also stressful. Chronic and unpredictable pain can be hard on your emotional and mental health.11

    Depression, anxiety, emotional distress, fearthese are responses to events in our lives that can change the way we daily live.

    Along with interfering with daily functioning, people with PHN often report feeling isolated. Sleep, which is essential to good mental health, is also a major problem for many people with PHN.

    It is important to recognize the emotional and mental impact of PHN, and understand that feelings of depression, anxiety, and fear are not unusual to experience when living with a chronic and unpredictable condition.

    If you can gain some control over your response to your symptoms, that can help reduce the stress of chronic pain. There are many things you can do to help yourself as described below.

    You may also want to seek professional help if you are experiencing emotions or thoughts that are too difficult to manage by yourself. Getting help is another way of helping yourself, and should be considered as just one more part of your self-care program.

    Self Care

    There are a number of things you can do to take care of yourself to help you manage the symptoms of PHN, including the mental and emotional challenges discussed above. Many of these self-care strategies are the same ones that help with overall physical and mental health. These include:

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    Is The Shingles Vaccine Safe

    The FDA have approved the use of both shingles vaccines in healthy adults over the age of 50.

    However, there are some instances in which a person should not get either vaccine â if they are pregnant or breastfeeding, allergic to any ingredient in the vaccine, or have a weakened immune system, for example.

    Offer Terms And Conditions:

    Shingles and Sleep: Understanding the Complex Relationship ...

    Patients are not eligible to use this card or participate in this program if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran Affairs healthcare, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico . Patient must have private insurance. Offer is not valid for cash-paying patients. The value of this card is limited to $250 per month per prescription or the amount of your co-pay, whichever is less . This program is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs. You must deduct the value received under this program from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf. You are responsible for reporting use of this program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the program, as may be required. You should not use the program if your insurer or health plan prohibits use of manufacturer co-pay cards. You must be 18 years of age or older to accept this offer. This offer is not valid where prohibited by law.

    Offer expires 12/31/2023.

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    How Is Postherpetic Neuralgia Treated

    If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir , valacyclovir or famciclovir . These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed.

    If your shingles outbreak is not caught early, your healthcare providers has many options to manage your postherpetic neuralgia symptoms.

    If your pain is mild, your healthcare provider may recommend:

    • Acetaminophen or NSAIDs such as ibuprofen .
    • Creams and patches include lidocaine and capsaicin .

    If your pain is more severe, your healthcare may prescribe:

    • Antiseizure drugs gabapentin and pregabalin .
    • Antidepressants, such as escitalopram , quetiapine or amitriptyline.
    • Botulinum toxin injections in the area where you are having pain.

    Theres no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. You and your provider will discuss options and what makes sense to try for you. Contact your provider if your pain is not lessening after taking your medicine. Take all your medications exactly as prescribed.

    A Word About The Shingles Vaccine

    If you are age 60 or over and have not had shingles, talk to your doctor about getting the shingles vaccine. Not only will it reduce your risk of developing shingles, but if you do develop shingles, youll be more likely to have a mild case. And, just as important, youll be much less likely to develop PHN if youve had the vaccine.

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    Cumulative Incidence Of Being Hz

    Figure shows the KaplanMeier curve of HZ-free survival for the sleep disorder patients and controls. The results show that the HZ-free rate was significantly lower for sleep disorder patients compared with the controls .

    KaplanMeir method comparing cumulative probability free of herpes zoster between patients with sleep disorders and comparison cohort.

    Incidence Rate And Risk Of Hz Between Sleep Disorder Patients And Controls

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    The incidence rates of HZ over time were higher in the patients with a sleeping disorder than in the controls . After adjustment for covariates, the patients with sleep disorders exhibited a 1.23-fold greater risk of HZ , as well as higher incidence rates in all age, sex, and comorbidity groups. The incidence of HZ increased with age for both cohorts and was higher for the patients in the SD cohort. After adjustment for covariates, the risk was the highest in the adults ages 65 years and older , followed in the adults ages 50 to 64 years , and in the adults ages 35 to 49 years compared with those younger than 35 years. No significant difference in the HZ risk was observed between the men and women. The incidence of HZ was greater in patients with any of the comorbidities than in the patients with no comorbidity. However, cancer and autoimmune diseases were independent risk factors of HZ .

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    Help Is Available For Phn

    Fortunately,early treatment for shingles can lower your chances of getting PHN.

    For some people, the pain becomes refractory, or resistant to treatment, explains Dr. Rosenquist. So we want to treat shingles as fast as we can ideally as soon as somebody feels a tingling or burning sensation, even before a rash develops.

    Sheadds that whenever nerve pain is involved, some people respond to treatment andsome dont.

    However,medications taken orally or injected that can target the affected nerves may beable to stun the nervous system into behaving properly. That meanstransmitting the appropriate signal to the brain.

    What Can I Do Right Now

    You can begin to help yourself right now to manage the challenges and stress of PHN by eating better, engaging in relaxation activities, improving your sleep, moving more, and maintaining social connection with others. Engaging in physical activity, even taking short daily walks, will help you feel better.

    You also can help yourself by learning about pain and how it works in the body. Once you learn the large role played by the brain in how you experience pain, it can help you take more control over your pain and become less fearful of it. Understanding the Complexity of Chronic Pain, a 10-minute video, is another good resource.

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