Shingles and Postherpetic Neuralgia

Also indexed as: Herpes Zoster (Shingles)

The virus that triggers chickenpox also causes shingles. Although no cure exists, treatments are available to relieve the rash and nerve pain. According to research or other evidence, the following self-care steps may be helpful:

Consider a topical ointment
To soothe pain, apply an ointment containing capsaicin, a substance found in cayenne peppers, four times a day

Try peppermint oil
Apply 2 to 3 drops to the affected area three or four times per day for pain relief

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full shingles article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About shingles

Shingles is a disease caused by the same virus (Varicella zoster) that causes chicken pox. Acute, painful inflamed blisters form on one side of the trunk along a peripheral nerve.

Shingles usually affects the elderly or people with compromised immune function. Nerve pain that persists after other symptoms have cleared is called postherpetic neuralgia.

Product ratings for shingles

Science Ratings	Nutritional Supplements	Herbs
		Cayenne (topical; for pain only)
		Peppermint oil (topical; for postherpetic neuralgia)
	Adenosine monophosphate (injection) Lysine Vitamin B12 (injection) Vitamin E	Liquorice (topical) Wood betony
See also: Homoeopathic Remedies for Shingles and Postherpetic Neuralgia
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Symptoms include pain, itching, or a tingling sensation prior to the appearance of a severely painful skin rash of red, fluid-filled blisters that later crust over. The rash is typically located on the trunk or face and only affects one side of the body. Pain may resolve rapidly or persist in the area of the rash for months to years after the rash disappears.

Medical options

Over-the-counter treatment for shingles might include analgesics, such as aspirin (Genuine Bayer®, Bufferin®, Ecotrin®), ibuprofen (Motrin IB®, Advil®), naproxen (Aleve®) or paracetamol (Tylenol®). Anti-itch creams containing antihistamines (Caladryl®) and hydrocortisone (Cortaid®, Lanacort®) might be useful. The oral antihistamine diphenhydramine (Benadryl®) might help reduce inflammation and itching. Topical capsaicin (Zostrix®) may provide temporary relief from postherpetic neuralgia pain.

Prescription drug treatment might include analgesics for pain relief, such as ibuprofen (Motrin®), naproxen (Naprosyn®), and paracetamol with codeine (Tylenol® with Codeine). Oral antibiotics such as cephalexin (Keflex®) and amoxicillin/clavulanate (Augmentin®) might be used to treat infected blisters. Other drugs used for short-term relief might include the antihistamine hydroxyzine (Atarax®); tranquilisers, such as lorazepam (Ativan®) and alprazolam (Xanax®); and oral corticosteroids, such as prednisone (Deltasone®) and methylprednisolone (Medrol®). Antiviral medicines such as oral acyclovir (Zovirax®), famciclovir (Famvir®), foscarnet (Foscavir®), and valacyclovir (Valtrex®) may also be prescribed.

Dietary changes that may be helpful

Varicella zoster, the virus that causes shingles, is a type of herpes virus. Another herpes virus, herpes simplex virus (HSV), has a high requirement for the amino acid arginine. On the other hand, lysine inhibits HSV replication.¹ Therefore, a diet that is low in arginine and high in lysine may help prevent herpes viruses from replicating. For that reason, some doctors advise people with shingles to avoid foods with high arginine-to-lysine ratios, such as nuts, peanuts, and chocolate. Nonfat yoghurt and other nonfat dairy can be a healthy way to increase lysine intake. This dietary advice for shingles has not been subjected to scientific study.

Lifestyle changes that may be helpful

Stress and depression have been linked to outbreaks of shingles in some,² ³ but not all,⁴ studies. ⁵ A small, preliminary study found that four children with shingles outbreaks, but who were otherwise healthy, all reported experiencing severe, chronic child abuse when the shingles first appeared.⁶ Among adults, how a stressful event is perceived appears to be more important than the event itself. In one study, people with shingles experienced the same kinds of life events in the year preceding the illness as did people without the condition; however, recent events perceived as stressful were significantly more common among people with shingles.

Vitamins that may be helpful

Adenosine monophosphate (AMP), a compound that occurs naturally in the body, has been found to be effective against shingles outbreaks. In one double-blind trial, people with an outbreak of shingles were given injections of either 100 mg of AMP or placebo three times a week for four weeks. Compared with the placebo, AMP promoted faster healing and reduced the duration of pain of the shingles.⁷ In addition, AMP appeared to prevent the development of postherpetic neuralgia.⁸ ⁹

Some doctors have observed that injections of vitamin B12 appear to relieve the symptoms of postherpetic neuralgia.¹⁰ ¹¹ However, since these studies did not include a control group, the possibility of a placebo effect cannot be ruled out. Oral vitamin B12 supplements have not been tested, but they are not likely to be effective against postherpetic neuralgia.

Some doctors have found vitamin E to be effective for people with postherpetic neuralgia—even those who have had the problem for many years.¹² ¹³ The recommended amount of vitamin E by mouth is 1,200–1,600 IU per day. In addition, vitamin E oil (30 IU per gram) can be applied to the skin. Several months of continuous vitamin E use may be needed in order to see an improvement. Not all studies have found a beneficial effect of vitamin E;¹⁴ however, in the study that produced negative results, vitamin E may not have been used for a long enough period of time.

Because shingles is caused by a herpes virus, some doctors believe that lysine supplementation could help people with the condition, since lysine inhibits replication of herpes simplex, a related virus. However, lysine has not been shown to inhibit Varicella zoster, nor has it been shown to provide any benefit for people with shingles outbreaks. Therefore, its use in this condition remains speculative.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

The hot component of cayenne pepper, known as capsaicin, is used to relieve the pain of postherpetic neuralgia. In a double-blind trial, a cream containing 0.075% capsaicin, applied three to four times per day to the painful area, greatly reduced pain.¹⁵ In another study, a preparation containing a lower concentration of capsaicin (0.025%) was also effective.¹⁶ Two or more weeks of treatment may be required to get the full benefit of the cream.

One case report has been published concerning an elderly woman with postherpetic neuralgia who experienced dramatic pain relief from topical application of 2 to 3 drops of peppermint oil to the affected area 3 or 4 times per day.¹⁷ Each application produced almost complete pain relief, lasting approximately 6 hours. The woman began to experience redness at the site of application after four weeks of use. The oil was therefore diluted by 80% with almond oil; the diluted preparation did not cause redness, and continued to produce "adequate" though somewhat less-pronounced pain relief.

Liquorice has been used by doctors as a topical agent for shingles and postherpetic neuralgia; however, no clinical trials support its use for this purpose. Glycyrrhizin, one of the active components of liquorice, has been shown to block the replication of Varicella zoster.¹⁸ Liquorice gel is usually applied three or more times per day. Liquorice gel is not widely available but may be obtained through a doctor who practices herbal medicine.

Wood betony(Stachys betonica) is a traditional remedy for various types of nerve pain. It has not been studied specifically as a remedy for postherpetic neuralgia.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

Acupuncture may be helpful in some cases of shingles and postherpetic neuralgia. Anecdotal case reports of people treated with electroacupuncture (acupuncture with applied electrical current) described improvement in seven of eight people.¹⁹ A controlled trial, however, found no difference in response between acupuncture treatment and placebo.²⁰ The authors of this trial reported some difficulty in evaluating the results due to difficulty in assessing measures of pain in this study group. Large, controlled trials using well-designed pain evaluation methods are still needed to determine the value of acupuncture in the treatment of shingles and postherpetic neuralgia.

Hypnosis has improved or cured some cases of postherpetic neuralgia, as well as the acute pain of shingles.²¹

References
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1. Tankersley RW Jr. Amino acid requirements of herpes simplex virus in human cells. J Bacteriol 1964;87:609–13.

2. Irwin M, Costlow C, Williams H, et al. Cellular immunity to varicella-zoster virus in patients with major depression. J Infect Dis 1998;178 (Suppl 1):S104–8.

3. Engberg IB, Grondahl GB, Thibom K. Patients’ experiences of herpes zoster and postherpetic neuralgia. J Adv Nurs 1995;21:427–33.

4. Schmader K, George LK, Burchett BM, Pieper CF. Racial and psychosocial risk factors for herpes zoster in the elderly. J Infect Dis 1998;178 (Suppl 1):S67–70.

5. Schmader K, Studenski S, MacMillan J, et al. Are stressful life events risk factors for herpes zoster? J Am Geriatr Soc 1990;38:1188–94.

6. Gupta MA, Gupta AK. Herpes zoster in the medically healthy child and covert severe child abuse. Cutis 2000;66:221–3.

7. Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 1989;21:265–70.

8. Sklar SH, Blue WT, Alexander EJ, et al. Herpes zoster. The treatment and prevention of neuralgia with adenosine monophosphate. JAMA 1985;253:1427–30.

9. Sklar SH, Wigand JS. Herpes zoster. Br J Dermatol 1981;104:351–2.

10. Schiller F. Herpes zoster: review, with preliminary report on new method for treatment of postherpetic neuralgia. J Am Geriatr Soc 1954;2:726–35.

11. Heyblon R. Vitamin B12 in herpes zoster. JAMA 1951;146:1338 (abstract).

12. Ayres S Jr, Mihan R. Post-herpes zoster neuralgia: response to vitamin E therapy. Arch Dermatol 1973;108:855–66.

13. Ayres S Jr, Mihan R. Post-herpes zoster neuralgia: response to vitamin E therapy. Arch Dermatol 1975;111:396.

14. Cochrane T. Post-herpes zoster neuralgia: response to vitamin E therapy. Arch Dermatol 1975;111:396.

15. Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 1989;21:265–70.

16. Bernstein JE, Bickers DR, Dahl MV, Roshal JY. Treatment of chronic postherpetic neuralgia with topical capsaicin. J Am Acad Dermatol 1987;17:93–6.

17. Davies SJ, Harding LM, Baranowski AP. A novel treatment of postherpetic neuralgia using peppermint oil. Clin J Pain 2002;18:200–2.

18. Baba M, Shigeta S. Antiviral activity of glycyrrhizin against varicella-zoster virus in vitro. Antivir Res 1987;7:99–107.

19. Coghlan CJ. Herpes zoster treated by acupuncture. Cent Afr J Med 1992;38:466–7.

20. Lewith GT, Field J, Machin D. Acupuncture compared with placebo in post-herpetic pain. Pain 1983;17:361–8.

21. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol 2000;136:393–9.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.