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Q: I developed shingles several months ago. The rash is gone, but I still have a lot of pain. What can be done about it?

Gilden, Donald H. M.D.

DEPARTMENT: Ask the Experts

Donald H. Gilden, M.D., is a professor and chairman of the Neurology department at the University of Colorado Health Sciences Center in Denver.

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A: Dr. Donald Gilden advises

Figure. D

Figure. D

Shingles (also called herpes zoster) causes a rash and pain. These symptoms usually occur in an area that corresponds to the region served by one or more nerve roots. The nerve cells that make up the nerve root become infected with the virus herpes zoster. The rash often disappears in about one week and the pain lasts four to eight weeks on average. Pain that continues beyond three months is called postherpetic neuralgia (PHN). Besides pain, people with shingles also experience allodynia, an extreme sensitivity to light touch over the skin.

PHN is a difficult problem to treat because there is no single medication that — like a magic bullet — makes it disappear. But several medications provide relief. Antiseizure medications, such as carbamazepine (Tegretol, Carbatrol) and gabapentin (Neurontin) have proven effective, as have antidepressants such as nortriptyline (Pamelor, Aventyl) and amitriptyline (Elavil, Endep). These drugs may be used in combination with extra-strength Tylenol or a narcotic, such as codeine. Research is underway to determine if PHN occurs because there is still a low-level herpes zoster infection in the nerve cells of the affected nerve root. Hopefully, these findings will lead to new treatments.

Discuss your problem with your neurologist. Since everyone responds differently to medication, it may take a trial-and-error approach to find the best solution for your pain.

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