In what order do the symptoms appear?
The order of symptoms is usually very similar. Often, pain initially occurs in the affected body part without visible skin changes. Pain is thus produced in the affected dermatome.
This means that the skin area supplied by the affected nerve cord is painful. Some affected persons also report sensations of discomfort. Often the first symptoms are tiredness, exhaustion, flu-like symptoms and fever.
Nausea and stomach pain can also occur. Some affected persons suffer from toothache, back pain or other pains before the rash breaks out. Only a few days later do discreet red spots appear in the affected nerve segment.
Usually, blisters form within the following 12 – 24 hours. After a few more days, the blisters fuse and may become cloudy. They fill with lymph fluid.
This is a protein-containing fluid in our body that leads to the cloudy color of the bubble contents. Pain and itching can occur. In the following days, the blisters usually burst open.
After that, yellow-brown bark forms within one to two weeks. With a good immune system, the skin changes and complaints are completely healed after 3-4 weeks without any consequences. In immunocompromised persons the nerves can be damaged.
Subsequently or delayed a few weeks after the disease is over, a so-called post-zosteric neuralgia can develop. In this context, shingles can cause chronic pain. This pain is described as neuropathic pain.
They are caused by damage to one or more nerves. The pain that occurs in this phase is often described as burning, electrifying and very strong. If the vesicles are scratched open during the disease, irreversible scars and pigmentation disturbances may develop and remain after the disease has healed.In some cases the rash may not appear at all. This is called post-herpetic neuralgia, where pain and discomfort are the main symptoms.
Course of the pain
The pain is often strong right from the start. In some cases, the sensation of pain increases with the appearance of the rash. Often the pain during the disease is described as dull, pulsating and stabbing.
A radiating pain may occur. This means that the pain extends beyond the area affected by the rash. Usually the intensity of the pain correlates with the trigger intensity.
When the immune system and the medication fight the viruses and the number of viruses decreases, the pain also decreases. If post-zosteric neuralgia develops after the rash has healed, neuropathic pain may develop. This pain is caused by damage to a peripheral or central nerve.
This is called peripheral nerve damage, because a particular nerve is affected in a particular part of the body and not in the brain. If a nerve in the brain has been damaged, it is called a central nerve disorder. In both cases there is a hyperactivation of the pain perception system.
Sodium channels are increasingly built into the brain. This leads to a more sensitive and faster pain perception. This neuropathic pain is chronic. It is independent of the trigger. It is often described as “tingling” and very strong and unpleasant.
