The disease is considered an extremely painful disease, which causes great suffering to those who suffer from it. It is very common, and according to statistics, about half of the people aged 85 and over in Israel have suffered from the disease. If the disease is not treated properly, especially among people aged fifty and older, the suffering from the disease can last for months or even many years. About 50% of the population aged 70+ suffer for years from the pains that accompany the disease, if they are not treated correctly.
The sophisticated mechanism of the herpes zoster virus
“The herpes zoster virus has a kind of multi-line ticket for traveling on public transportation of the body’s nervous system,” explains Dr. Haim Moshe Adhan from the Center for Advanced Pain Treatment. coming out of the spinal cord. In this way the virus “takes a ride” and also reaches the nerves in the skin – where it attacks. At a young age the virus escapes from the skin to the DRG – where it sits balanced against the immune system for decades. At a later age, in a situation where the immune system is attacked and found weak, it breaks out.”
According to Dr. Adhan, “the virus is characterized by two main features: wisdom and patience. It is smart because it attacks people with a weaker immune system, especially the elderly or people with diabetes, cancer, or other diseases that weaken the immune system; It is tolerant because it settles in a kind of hiding in the human body in the DRG, near the spinal column in the nervous system, and waits for the right moment to attack – a wait that often lasts for many years. The moment the virus detects the weakening of the immune system, as for example in cases of advanced age, difficult life events affecting the patient, infection with the corona virus, chemotherapy treatments and more, it attacks.”
What are the symptoms of shingles?
“Shingles manifests itself in the form of red and painful blisters on the skin, usually on one side of the body, in an area connected to one nerve root called a dermatome.”
How long is the pain caused by shingles expected to last?
According to Dr. Adhan, the answer to this depends very much on the age of the patient. You can see the distribution in the table below, based on the data of the–New England Journal of Medicine
Is the medication effective?
There are a variety of medications to treat shingles, but according to Dr. Adhan, the findings of a study published in 2014 in the New England Journal of Medicine It was suggested that unfortunately, most patients choose treatment using anti-neural pain medications that are included in Israel’s health basket, and are proven to be ineffective in most patients with the disease. This situation is even more difficult among adults, according to him, because they have no endurance to contain different doses of the same drugs without suffering from problematic side effects such as addiction, lack of concentration, constipation and even death. These drugs are usually originally intended for the treatment of seizures and/or depression and not for the treatment of shingles. Thus, for example, anticonvulsant drugs such as pregabalin and gabapentin had a 22% chance that the treatment would reduce at least half of the pain, and the proportion of patients who stopped the treatment due to problematic side effects was 40%.
At the same time, 34,000 American doctors specializing in neurology signed a position document in 2018[3] The reader not to give strong narcotics such as Percocet, Targin, Oxycontin or Pentax patches in combination with Butranez as treatment for patients with shingles mainly because of their inefficiency and the fear that they will lead to severe side effects[ii].
Photo: shutterstock CHOTE BKK
What, after all, may prevent pain?
vaccinations
“Vaccines against shingles are considered effective in preventing the disease.” However, according to Dr. Adhan, “the vaccines do not help patients who already have the disease. Similar to the corona virus, a patient who recovers from the disease carries with him the viruses of the disease and does not need to be vaccinated for at least six months from the moment of his/her illness. After that six months, it is recommended to get vaccinated in order not to get infected again, as can happen in a third of the cases.”
Antiviral treatment
According to Adhan, “If urgent treatment is needed, antiviral treatment based on acyclovir such as Zovirax can be considered. If the drug is taken within 3 days of the first feeling of pain, the treatment can prevent ongoing pain in some cases, and ease the severity of the viral infection.”
Botox injections
According to Dr. Adhan, Botox injections to treat the pain caused by shingles have been proven to be much more effective than the drugs that are currently in the health care basket to treat the pain of the disease. “According to the data of many scientific studies, injecting Botox directly into the affected area significantly reduces the pain caused by the disease. Similar to the virus, Botox also knows how to reach the infected nerve root in a targeted manner and treat it. For this reason, many pain doctors have called Botox a smart bomb in the fight against nerve pain.”
Botox has 12 different mechanisms to relieve nerve pain[4]. Four out of five patients with nerve pain due to shingles who received Botox treatment reported greater than 50% pain relief within weeks. This, without significant side effect [5][6].
According to Dr. Adhan “the injections themselves are delivered into the first layer of the skin and not into deeper tissues, which makes the treatment relatively safe and without the risk of problematic side effects. The injections are given under sedation with laughing gas, which allows treatment without the feeling of pain.” This treatment has been recommended for over a decade by the Canadian Pain Associations in America and Europe. [7] [8]
In conclusion, shingles is considered a disease that causes particularly severe pain and is currently ranked among the five most severe pains for a person. Without appropriate treatment, the disease may last a long time and cause great suffering to patients, especially among people aged 50 and over. There are several effective treatment and prevention methods for the disease, including preventive vaccination, antiviral drugs and Botox.
In any case of suspicion of illness, one should seek treatment and/or medical advice.
The article in collaboration with Dr. Haim Moshe Adhan, One of the top experts in the field of pain in Israel, the founder of the Center for Advanced Pain Treatment for Multidisciplinary Pain Rehabilitation.
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