Therapy

Since the “zosterschmerz” is a symptom of the actual basic disease shingles, the early fight against shingles is in the foreground of a therapy. This is also a prophylactic measure to prevent the development of “postzosteric neuralgia“. Consequently, the aim of this therapy is to prevent the spread of the viruses, to relieve acute pain and to prevent post-zosteric neuralgia.

Initially, virustatics such as Aciclovir and Brivudin are used to contain the virus activity. This also helps the skin changes heal faster. In addition, local anesthetics are used to reduce pain and itching.

In some cases, however, the measures taken to combat acute shingles are not prophylactically effective enough to prevent the development of post-zosteric neuralgia. The treatment of post-zosteric neuralgia is different from the treatment of acute shingles. Virustatics are usually no longer administered, since the actual viral infection has usually subsided long ago.

Instead, the following other types of medication are used for pain relief: anticonvulsants Opioids Tricyclic antidepressants

Anticonvulsants
Opioids
Tricyclic antidepressants

Anticonvulsants were primarily developed for the treatment of epilepsy, but are now also used primarily in pain therapy. The active ingredients gabapentin and carbamazepine are frequently used in the treatment of post-zosteric pain. Opioids are usually used to treat severe pain, e.g. tumors, and some of them fall under the narcotics law due to their strong effect.

There are therefore special guidelines for taking and carrying these drugs. Antidepressants are primarily drugs used to treat depression or other diseases that cause anxiety. However, the so-called tricyclic antidepressants are also effective for chronic pain symptoms.

The most frequently used active ingredients are amitriptyline, desipramine, imipramine and doxepin. Even in small doses they have a pain-relieving effect and also have a positive influence on sleep and mood. Some of these drugs are also used for pain relief in cases of shingles on the head.

In addition, local anesthetics are used in some cases. These are for example lidocaine patches or capsaicin creams. Lidocaine reduces the excitability of pain-conducting nerve fibers by blocking sodium channels.

Capsaicin is a vegetable extract from cayenne pepper and is used for external application in cases of muscle tension, among other things. Its analgesic effect is based on the biochemical mechanism of inhibiting the reuptake of the mediator substance P at nerve endings. This reduces the transmission of the pain stimulus.

On the other hand, capsaicin causes the blood vessels to dilate locally through irritation, which leads to a strong increase in blood flow and heat development. However, the irritant effect can lead to sensitivity reactions and side effects such as severe burning and itching. If the post-zosteric neuralgia persists for less than six weeks, a sympathetic blockade can also reduce the pain.

However, if the pain lasts longer and cannot be sufficiently relieved by other medications, acupuncture treatments and the so-called transcutaneous electrical nerve stimulation, or TENS for short, are used as alternatives.Electrodes glued to the skin transmit light stimulation current pulses to the nerve fibers. This suppresses the transmission of pain and thus also the perception of pain. However, it often comes to a habituation to the current pulses, so that TENS is not yet a long-term therapy option.

For some patients, gentler measures are also helpful. Psychotherapy or relaxation techniques help on a mental level to process the pain and deal with it. Operative measures are only rarely considered.

Here, for example, there is the option of an anterolateral chordotomy. This means that the nerve tracts in the spinal cord that are responsible for the conduction of pain are surgically severed. As with all surgical procedures, the possible complications of damage to other nerve tracts or the surgical procedure in general must be taken into account.

In addition to the classic painkillers (e.g. ibuprofen or paracetamol), numerous other preparations, so-called co-analgesics, are available for the treatment of pain occurring in the context of shingles. This is because the virus damages the nerve in the area of the nerve fibre. However, the above-mentioned painkillers are mainly effective at the nerve endings in the skin area and must therefore be supplemented with the co-analgesics.

Depending on the intensity of the pain, therapy is initially carried out with paracetamol or ibuprofen in combination with weak opioid analgesics (e.g. codeine). If the symptoms persist or in the case of post-zosteric neuralgia, strong opioids (morphine) or co-analgesics (anticonvulsants, antidepressants, local anesthetics) are often prescribed subsequently. In children, therapy with ibuprofen or paracetamol is usually sufficient.

In addition to drug-based pain therapy, there are other procedures available that can accompany pain therapy. Transcutaneous electrical nerve stimulation (TENS) is often used, in which electrical stimulation in the area of the pain is used to create sensations that can relieve local pain. Alternatively, physical therapy, occupational therapy or psychotherapy can also lead to pain relief.

Drug therapy for shingles is intended to relieve acute pain as well as to reduce the risk of complications (post-zosteric neuralgia). Various classes of medication with different modes of action are available for this purpose. For mild pain and in children, a therapy of several days with NSAIDs such as ibuprofen or paracetamol is recommended.

If the pain gets worse, the medication can be supplemented with weak opioids (e.g. codeine). In contrast, other medications are used for very severe pain or in the treatment of post-zosteric neuralgia. In addition to the use of strong opioids (e.g. morphine), so-called co-analgesics play a major role here, as they suppress the pain directly at the damaged nerve fibre in comparison to the other preparations.

The tricyclic antidepressant amitriptyline or various epilepsy drugs (gabapentin, pregabalin) are frequently used here. These block various channels of the nerve fiber, which means that the pain stimulus cannot be transmitted. An alternative is the local application of local anesthetics (lidocaine, capsaicin) in the form of plasters, which can also lead to pain relief. ! and Zostex and shingles – is this compatible?