Dear Aaron,
I am so sorry you are going through this right now. I understand the agonizing, lancinating pain, sleepless nights, and suffering.
I am a Nurse Practitioner in the States. I have had Herpes Zoster-Shingles in my right ear every three to five weeks for the past twenty-one years and twice in my right eye.
This is a summary of the stages, signs and symptoms of Herpes Zoster-Shingles, and medical management of the disease.
During the Pre-eruptive Phase, you may have some of the following symptoms:
Duration 1-10 Days, but the rash occasionally takes much longer to appear
Headache
Photophobia
Generalized Aches and Pains
Fever, Chills, and Sweating
Enlarged Lymph Nodes near the pain and rash
Fatigue and Exhaustion
Pain usually preceding the rash
Description of pain: deep burning or aching pain, or electric shock–like pains, like a cattle prod, taser, etc.
Acute Eruptive Phase
Rash of grouped vesicle-blisters in a dermatomal pattern.
Occurs in waves or crops over a period of 5-7 days.
Vesicle-blisters look dissimilar and are of different sizes.
The rash is on a red base.
The pain may continue to increase into the second and third week.
The clear vesicle-blisters cloud over, look like pustules, scab over, and turn black. This process may take between 2-4 weeks. Once every vesicle-blister has scabbed over, you are no longer infectious!
You are considered infectious (contagious) if your rash is open to the air, ie not covered, to anyone who has not had chickenpox. This includes all pregnant women! Remember, not all women know they are pregnant!
Chronic Phase (Post Herpetic Neuralgia PHN)
30 days after onset of rash. Definition varies
Duration may last months or years after initial episode of Herpes Zoster-Shingles.
The resolution of the scars can take up to a year to heal.
Management and Medications
ANTIVIRALS: THE CORNERSTONE OF TREATMENT
Famciclovir 500 mg 3x daily 7-10 days, sometimes 14 days.
Smallest Tablet
Convenient dosing
Least Resistance
Most efficacious
Valcyclovir 1000 mg 3x daily 7-10 days
Large Tablets difficult to swallow for some
Based on Acyclovir
Acyclovir 800 mg 5x daily 7-10 days
Inconvenient Dose Schedule
Growing Resistance to Varicella Virus
Acyclovir is the antiviral most often prescribed in the UK.
What dosage of the medication are you on? Sometimes, the Physician places the patient on a lower dose, but needs to increase it to help with the pain-itching.
Sometimes, you need to be placed on a cocktail of medications, as they will work synergistically to help you. These are all by prescription. I have grouped them according to class. A clinician would start with one from the Anticonvulsant class, taper the dosage up, then one from the Antidepressant Class, etc. This list is by no means complete.
ANALGESICS
NSAIDS
Ibuprofen
Naprosyn
Acetominophen
OPIOIDS
Oxycodone
Hydrocodone
Codeine
CBD
ANTI-CONVULSANTS
Gabapentin-Neurontin
Pregabalin-Lyrica
ANTI-DEPRESSANTS
SNRIs
Cymbalta
Effexor-Venlafaxine
HETEROCYCLICS
Nortriptyline
Amitriptyline
2. I would find 100% cotton knit clothing. Make sure there are no seams to irritate your skin. The cotton knit is the most breathable, least irritating cloth to most individuals.
3. Use Lidocaine Cream or Spray OTC topically to help with the pain- itching, eg, Solarcaine with Aloe or Bactine. Many on this forum feel either Lidocaine or Benzocaine help with the pain-itching. The cream might soothe the inflamed nerve endings better and last longer on the skin. You can only use Lidocaine 12 hours on and 12 hours off, as the usefulness will extinguish itself.
4. Use ice or cool compresses. Do not take hot showers, as it will only increase the pain-itching
5. You need to rest and sleep. You cannot power through this disease. Do not go back to work! This virus is way stronger than you are, and you will only get more pain, the more exertion you do. Physical activity worsens the pain.
6. Most Importantly, get the Shingrex Immunization. It is a two phase vaccine, two months apart. It is given intramuscularly. It is highly efficacious in stopping Post Herpetic Neuralgia PHN and recurrent episodes of Herpes Zoster-Shingles.
Shingrex is available in the US at the pharmacy and covered by insurance if you are over 50 years of age. If you are younger than 50, and have had a documented case of shingles, it is still covered.
If you are in the UK/Canada/Australia/NZ, I know it has been distributed there, but the national health insurance may not cover it until age 70, which is ridiculous. It is expensive, but I would have paid thousands not to have recurrent shingles.
Aaron, we are here to support you. Go to your Physician and request opioids ie oxycodone for the severe pain, plus Gabapentin to help with the Neurogenic pain. We understand the excruciating pain. If your Physician refuses, it is time to switch Physicians.
Best Wishes.
Merry Juliana