While a case of shingles may be relatively benign for someone in her thirties, the disease can be extremely painful for the elderly, in whom it is much more common. (By age 80, half of all people have had shingles.)
Besides age, factors that increase risk for shingles include stressful life events and immune-compromising conditions such as cancer, HIV infection and an organ transplant. Leading health resources paint a grim picture of the disease in its more serious manifestations:
Severity, Range of Symptoms
* From http://nihseniorhealth.gov (National Institute of Allergy and Infectious Diseases):
"The pain of shingles can be debilitating. If it is severe and persists for months or years, it is called postherpetic neuralgia (PHN). And unfortunately, persistent pain is a common symptom in people over 60."
"Outbreaks that start on the face or eyes can cause vision or hearing problems. Even permanent blindness can result if the cornea of the eye is affected."
"Bacterial infection of the open sores can lead to scarring. In a very small number of cases, bacteria can cause more serious conditions, including . . . necrotizing fasciitis, a severe infection that destroys the soft tissue under the skin."
"The burning waves of pain, loss of sleep, and interference with even basic life activities can cause serious depression."
"In patients with immune deficiency, the rash can be much more extensive than usual and the illness can be complicated by pneumonia."
* National Institute on Aging:
"For some people, PHN is the longest lasting and worst part of shingles. The pain can make some people feel weak and unable to do things they usually enjoy. Those who have had PHN say the pain is sharp, throbbing, or stabbing. Their skin is so sensitive they can't bear to wear even soft, light clothing."
"The older you are when you get shingles, the greater your chance of developing PHN. This pain can last for weeks, months, or even years."
On Treatment for Shingles
* National Institute on Aging:
Among the medications your doctor may prescribe for severe symptoms are antiviral drugs to fight the virus; steroids to lessen pain and shorten the time you're sick; antidepressants and anticonvulsants to help with pain relief; and analgesics to reduce pain.
"When started within 72 hours of getting the rash, these medicines help shorten the length of the infection and lower the risk of other problems."
On Treatment for PHN
* New York's Beth Israel Medical Center, Department of Pain Medicine and Palliative Care:
"There are no treatments that reverse the nerve damage caused by shingles . . . [or] improve the healing of the nerves. . . . Each patient with PHN should be tried on a variety of [pain] medications until the drug or combination of drugs is found that gives good pain relief with no or little side effects."
Treatments include a topical lidocaine patch to treat pain; anticonvulsants such as gabapentin (Neurontin) and carbamazepine (Tegretol); tricyclic antidepressants; opioids such as oxycodone, morphine and methadone; and nondrug therapies such as relaxation and biofeedback.