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Sjogren's and Shingles

Q: My mother, age 74, has Sjogren's but recently developed Shingles on her trunk. It's been 3 weeks and the pain is excrutiating.  The rash is fading but she said the pain is worse then before.  She is taking an anti-anxiety med and 2 pain meds.  She also went to a pain clinic and they gave her an epidural.  Any other suggestions?

A: Persistent pain following Shingles (Herpes Zoster virus) is termed post-herpetic neuralgia. In my experience, the best approach is to treat early with anti-virals and neuroleptic medications like Neurontin (gabapentine - generic). When the pain persists after the vesicles have healed - neuroleptics or anti-depressant type meds are used, along with opioid med like Vicodin (hydrocodone - generic). Topical analgesics like Lidocaine patches can be used if the rash has healed and the area affected is small. Adequate pain control is important to try to prevent development of chronic pain. Often patients are reluctant to take the medications needed, but it is better to take them to try to prevent chronic pain. Sometimes it can take 3-6 months before the pain starts to resolve.

A search on PubMed will reveal other treatments that have been reported. One meta-analysis is found here: http://www.ncbi.nlm.nih.gov/pubmed/22085778

dr c

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