Neuralgia
What is shingles?
Shingles (herpes zoster) is an infection that causes a painful rash. It is caused by the varicella-zoster virus (VZV). This is the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body. It may not cause problems for many years. But as you get older, the virus may become active again and cause shingles.
Is shingles contagious?Shingles is not contagious. You cannot get shingles from someone else. But you can catch chickenpox from someone with shingles if you have direct contact with fluid from their shingles rash.
The risk of spreading the virus is low if the shingles rash is kept covered. People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts.
Who is at risk for shingles?Anyone who has had chickenpox can get shingles. But the risk of shingles goes up as you get older. Shingles is most common in people over age 50.
People with weakened immune systems are at higher risk of getting shingles. This includes those who:
- Have immune system diseases such as HIV
- Have certain cancers
- Take medicines that weaken their immune system, such as steroids and medicines you take after organ transplant
Your immune system may be weaker when you have an infection or are stressed. This can raise your risk of shingles.
It is rare, but possible, to get shingles more than once.
What are the symptoms of shingles?Early signs of shingles include burning or shooting pain and tingling or itching. It is usually on one side of the body or face. The pain can be mild to severe.
Up to several days later, you will get a rash. It consists of blisters that typically scab over in 7 to 10 days. The rash is usually a single stripe around either the left or the right side of the body. In other cases, the rash is only on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread. It might look similar to a chickenpox rash.
Some people may also have other symptoms:
- Fever
- Headache
- Chills
- Upset stomach
Shingles can cause other problems (complications):
- Postherpetic neuralgia (PHN) is most common complication of shingles. It causes severe pain in the areas where you had the shingles rash. It usually gets better in a few weeks or months. But some people can have pain from PHN for many years, and it can interfere with daily life.
- Vision loss can happen if shingles affects your eye. It may be temporary or permanent.
- Hearing or balance problems are possible if you have shingles within or near your ear. You may also have weakness of the muscles on that side of your face. These problems can be temporary or permanent.
Very rarely, shingles can also lead to pneumonia, brain inflammation (encephalitis), or death.
How is shingles diagnosed?Usually your health care provider can diagnose shingles by taking your medical history and looking at your rash. In some cases, your provider may scrap off tissue from the rash or swab some fluid from the blisters and send the sample to a lab for testing.
What are the treatments for shingles?There is no cure for shingles. Antiviral medicines may help to make the attack shorter and less severe. They may also help prevent PHN. The medicines are most effective if you can take them within 3 days after the rash appears. So if you think you might have shingles, contact your provider as soon as possible.
Pain relievers may also help with the pain. A cool washcloth, calamine lotion, and oatmeal baths may help relieve some of the itching.
Can shingles be prevented?There is a vaccine, called Shingrix, to help prevent shingles and its complications. The Centers for Disease Control and Prevention recommends that healthy adults 50 years and older get the vaccine. Your provider might also recommend the vaccine if you are over 19 and have a weakened immune system. The vaccine is given in two doses.
If you have shingles, you can help prevent spreading the virus to others by:
- Staying away from:
- People with weakened immune systems
- People who have not had chickenpox or the chickenpox vaccine, especially if they are pregnant
- Premature or low birth weight babies
- Keeping the rash covered
- Not touching or scratching the rash
- Washing your hands often
Centers for Disease Control and Prevention
Neuralgia FDA Approved Drugs
- Treatment with gabapentin, including treatment of neuropathic pain, including neuropathic pain associated with postherpetic neuralgia.
- Management of postherpetic neuralgia (phn) in adults.
- Treatment of moderate-to-severe primary restless leg syndrome in adults.
- Management of fibromyalgia.
- Treatment of pain, including neuropathic pain associated with diabetic peripheral neuropathy or spinal cord injury, postherpetic neuralgia, and fibromyalgia.
- Treatment of pain.
Felter's Materia Medica on Neuralgia
   The bark and fruit of Aesculus glabra, Willdenow (Nat. Ord. Sapindaceae). A small fetid tree common to the central portion of the United States. Common Names: Ohio Buckeye, Smooth Buckeye,... / ...to determine its status as a remedy for nervous disorders, and especially its control over visceral neuralgias. 1
   The (1) dried root and the (2) dried leaves and tops of Atropa Belladonna, Linné (Nat. Ord. Solanaceae). Europe and Central Asia; also... / ...abscesses, incipient and recurrent boils, buboes, hemorrhoids and fissures, inflamed glands, and in neuralgia, chronic rheumatism, lumbago, myalgia, pleurodynia, the chest pains of pulmonary tuberculo...1
   The fresh, green stems and the flowers of Selenicereus grandiflorus (L.) Britt. & Rose (and other Selenicereus speciesMM) (Cereus grandiflorus,... / ...ritant to the cardiac ganglia, producing thereby irritability, hyperaesthesia, arrythmia, spasm and neuralgia of the heart, and even carditis and pericarditis. According to E. M. Hale, M.D., it acts. ... / ...organ were held with a strong band, it is often the most prompt of all cardiac remedies. It is a good remedy in the heart troubles produced by to1
   A stearopten (having the nature of a ketone) derived from Cinnamomum Camphora. (Linné), Nees et Ebermeier (Nat. Ord. Lauraceae). China and... / ...ocations, for the relief of pain, stiffness, soreness and swelling, as in myalgia, facial and other neuralgias, and upon rheumatic joints, deep inflammations, chronic indurated glands and other indura... / ...due to gaseous distention of the stomach, or to nervous irritability. In occipital headache, from mental strain, or overstudy, small doses of 1
   The dried beetles, Cantharis vesicatoria (Linné), De Geer. (Ord. Coleoptera.) Southern Europe. Dose, 1 grain. Common Name: Spanish Fly; Synonym:... / ...pseated inflammation, to absorb inflammatory products, and to relieve local pain, as in intractable neuralgias and persistent headache. In Eclectic therapy the use of blisters is scarcely ever deemed ...1
   The ripe fruit, dried, of Capsicum frutescens, Linné (Nat. Ord. Solanaceae). Tropical America; also cultivated in most tropical countries. Dose,... / ...relief to so-called chronic rheumatic pains, and be applied in lumbago, pleurodynia and intercostal neuralgia. A stupe of hot water and capsicum applied to the nape of the neck sometimes relieves the ...1
   The unexpanded flowers (dried flower-buds) of Eugenia aromatica (Linné), O Kuntze. (Jambosa Caryophyllus (Sprengel) Niedenzu). (Nat. Ord.... / ...al pain and sometimes earache. Used pure or in ointments or liniments it relieves local pain, as in neuralgia, and in chronic eczema it allays itching, and is sometimes added to embrocations to give t... / ...oil of clove frequently relieves it. Eugenol. Derived from oil of clove and other sources may be given in doses of 1 to 3 minims.1
   The whole plant of Chelidonium majus, Linné (Nat. Ord. Papaveraceae). Europe naturalized in waste places in the United States. Dose, 1 to 60... / ...ich they depend. When hemorrhoids, splenic congestion, dyspepsia, headache, migraine, supra-orbital neuralgias and cough are dependent mostly upon the liver disorders helped by chelidonium, they are p...1
   ...ng, twisting, boring, or tearing character, and if of the bowels, a desire to go to stool; visceral neuralgia, with cutting pain; dysentery, with tormina, and small passages of mucus, or diarrhoea wit...... bryonia should be considered. The dose should not be large enough to purge. Colocynth is useful in neuralgia of the viscera in the parts supplied by the splanchnic nerves, as neuralgic colic. Other n......hnic nerves, as neuralgic colic. Other nerve endings seem to respond to it, for it relieves ovarian neuralgia, orchialgia, and sometimes neuralgia of the fifth nerve, when the characteristic cutting p...1
   The full grown fruit, gathered green, of Conium maculatum, Linné (Nat. Ord. Umbelliferae). Europe and Asia; naturalized in the United... / ...the drug, it is best adapted to peripheral pain with excessive mobility. Thus it relieves spasmodic neuralgia, neuralgia from carious teeth, ovarian neuralgia, and gastralgia. In gastric ulcer it is q... / ...be applied and be given to relieve pain even when a cure is not possible. It relieves the pain of swollen mammae during the menstrual periods a1
   The ripe fruit and bark of (1) Crataegus Oxyacantha, Linné, and (2) other species of Crataegus. (Nat. Ord. Rosaceae) 1. England and other parts... / ... or without enlargement of the rings, rheumatism of the heart, dropsy depending on heart disorders, neuralgia of the heart, tachycardia, and in atheromatous conditions of the vessels. The exact indica... / ...trial; and as yet with no rational explanation of its reputed powers. The smaller doses are suggested as more likely to succeed than full doses.1
   The rhizome and rootlets of Cypripedium pubescens, Swartz; and of Cypripedium parviflorum, Salisbury. (Nat. Ord. Orchidaceae.) Rich woods of the... / ...c Medicine Cypripedium. Dose, 5 to 60 drops. Specific Indications.Insomnia, nervous irritability, neuralgia and delirium, all from atony; restlessness and muscular twitching, typhomania and tremors ... / ...Simple Syrup, enough to make 3 fluidounces. Mix. Sig.: Dose, 5 to 20 drops. If nausea occurs lessen the amount of, or omit the lobelia.1
   The rhizome of Dioscorea villosa, Linné (Nat. Ord. Dioscoreaceae). A vine found throughout the United States. Dose, 5 to 60 grains. Common Names:... / ...ntraction of the muscular tissues, in cholera morbus, indigestion, and dysenteric tenesmus. Ovarian neuralgia and spasmodic dysmenorrhea sometimes yield quickly to it. In all disorders it seems best ... / ...does not dissolve calculi. Usually, while there is much tenderness in cases requiring dioscorea, the distress is gradually relieved by pressure.1
   The leaves of Eucalyptus Globulus, Labillardiere. Collected from the older parts of the tree. (Nat. Ord. Myrtaceae.) A native tree of Australia;... / ...sed for many of the complications or results of chronic malarial cachexia, as periodic headache and neuralgia. It is only in occasional cases of malarial fever that it does a great deal of good, espec... / ...to indications as given above, eucalyptus is a very satisfactory and pleasant medicine. It is best given in syrup or glycerin.1
   The leaves of Gaultheria procumbens, Linné (Nat. Ord. Ericaceae). Damp woods and sandy soils of eastern third of the United States. Common... / ... gonorrheal rheumatism, a specific gonorrheal arthritic infection. Small doses have relieved facial neuralgia and tic douloureux; and sometimes it exerts a soothing and antiseptic effect in acute gono... / ...of infants. Gaultheria is an agent of special value as a flavoring agent and preservative for water-dispensed medicines in the summer season. Fo1
Physician's Materia Medica on Neuralgia
   The tuber, also the leaves (unoflicial) of ACONITU M NAPELLUs, Lin. Actively poisonous. A powerful cardiac depressant acting thus as an arterial sedative; paralyzes sensory nerves and depresses respiratory centers. Used chiefly for its antipyretic effect and in treatment of neuralgia, rheumatism and cardiac hypertrophy; local ly, in liniments, for relief of pain. Dose, 0.015 to 0.12 Grm. (% to 2 grs.).2
   Stimulant expectorant, alterative, hepatic stimulant. Used es pecially in bronchitis, acute or chronic, in hepatic torpor and catar rhal jaundice, in neuralgias and as a resolvent in glandular enlarge ments. Dose, as expectorant, 0.13 to 0.6 Grm. (2 to 10 grs.); as hepa tic stimulant, 0.6 to 2.0 Grm. (10 to 30 grs.).2
   An active irritant poison. In small doses a powerful alterative. tonic, hematinic and antiperiodic. Prescribed in chronic cutaneous diseases, secondary syphilis, chorea, neuralgia and malarial fevers. a. Arsenous Bromide. Has been used especially in diabe tes. Dose, 0.0015 to 0.006 Grm. (1-40 to 1-10 gr.). b. Arsenous Chloride. Dose, 0.002 to 0.004 Grm. (1-30 to 1-15 am). For formulas see in Part II, Alteratives ( a) and Tonics (i). c. Arslenous iodide. Particularly useful in syphilis and obstin2
   The rhizome and roots of CIMICIFUGA RACEMOs.-l, (L.) Nutt. Alterative, antispasmodic, uterine sedative. Prescribed in rheumatism, chorea, dysmenorrhea. ovarian neuralgia, asthma, spasmodic aflections gener'aliy, head ache, etc.2
   The flowering tops of the pistillate plant of CANNABIs sa'r1vA, Lin., grown in the East Indies. Antispasmodic, analgesic, deliriant. aphrodisiac. Locally applied it is anti-pruritic. Prescribed in teta nus, in neuralgia, in insomnia and other conditions depending on anemia of the brain, in combating the morphine habit, etc. Dose, 0.2 to 0.6 Grm. (3 to 10 grs.) or more.2
   The bark of an undetermined Bolivian tree, probably a species of NECTANDRA. The “Coto” commonly in use in this country is the variety which was formerly called “Paracoto.” Aromatic, astring ent, anodyne. Prescribed in obstinate diarrheas. in night sweats, neuralgia and rheumatism.2
   The compounds of Gold have an action on the human system resembling that of mercurial salts. They modify and improve nu trition in cachectic conditions, stimulate the various emuctories and apparently give tone to the nervous system. They are hence prescribed in neurasthenia, in hysteria, in neuralgia (particularly ovarian) and in methomania. as well as in scrofula and chronic syphilis and rheumatism. a. Gold Bromide. Dose, 1-30 to 1-15 gr. The salt shows distinctly the sedative action of the br2
   The bark, also the fruit of AESCULUS HIPPOCASTANUM. Lin. Tonic, astringent, antiperiodic and slightly narcotic. Used in ma larial fevers and in neuralgias of malarial origin.2
   A derivative of NITRO-PHENOL. Analgesic. antipyretic. Prescribed for relief of pain in acute rheumatism, sciatica, gastralgia, migraine, dysmenorrhea, neuralgia. etc.; to reduce temperature and promote diaphoresis in fevers, and for a specific influence in diabetes. Dose, 0.12 to 0.60 Grm. (2 to 10 grs.).2
   The root of ASCLEPIAS TUBEROsA, Lin. Diaphoretic, expec torant, carminative, antipyretic; in large doses emetic and cathartic. Prescribed in the formative stage of fevers, in coryza and acute nasal catarrh of infants, in colliquative sweats of phthisis, in pleurodynia, intercostal neuralgia and rheumatism.2
Physician's Therapeutics Memoranda on Neuralgia
   For immediate relief, prescribe acetanilid, phenacetin or anti pyrin usually conjoined with caffeine and potassium or sodium bro mide, sometimes gelsemium or cannabis indica; locally, liniments of aconite or chloroform; menthol, chloride of methyl spray; applica tions of electricity; hypodermatic injections of morphine and atropine (only when nothing else will serve). .In the general treatment, strychnine, arsenic and iron are the most generally useful remedies, but attention must always be give...2
   General treatment for neuralgia. Hypodermatic iniections of atropine in heroic doses (1-20 grain) is highly recommended by some to cut short the attack. Others advise acupuncture or local massage or the ether spray, applied daily, or the hypodermatic use of morphine or of chloroform. In any case the hot water bottle and liniments of chloroform, aconite, methyl salicylate and menthol are remedies of value.2
References
2) Nelson, Baker & Co., 1904, Physician's Handy Book of Materia Medica and Therapeustics, Detroit, Michigan.
