Shingles Among Most Painful Medical Conditions

Shingles (herpes zoster) has a deserved reputation for being an extremely painful and debilitating medical condition. Both the National Health Service in the United Kingdom and AARP in the United States recently included it on their respective lists of most painful medical conditions. 

Statistically, one in three adults in the United States will develop shingles during their lifetime. More than 99% of Americans over the age of 50 have had chickenpox, putting them at risk of the virus reactivating as shingles. About half of all cases occur in people over the age of 60, but many younger individuals are also at risk.

“Age is the major risk factor because everyone’s immune system normally declines with age, and quite noticeably so starting around age 40,” explains neurologist Anne Louise Oaklander, MD, PhD, director of the nerve unit at Massachusetts General Hospital. “But the other thing to note is that in addition to age, anything else that suppresses your immune system is a known risk factor. That includes patients who have chronic diseases such as heart failure, kidney failure, malnutrition, patients who’ve had fractures or injuries, patients who are planning elective surgery, patients who have any kind of early stage cancer including precancerous lesions, and anyone who has rheumatoid arthritis or other disease that might require treatment with steroids.”  

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In addition to the painful rash that emerges in virtually all shingles patients, more than one-third of them develop complications after the rash subsides. Two of the most common are postherpetic itch (PHI) and postherpetic neuralgia (PHN), both a result of persistent nerve damage inflicted by shingles.

The CDC reports that shingles rates have been on the rise in the United States, although the reasons are unclear. While the upward trend continues among younger and middle aged adults, the rates among older adults have been plateauing since 2008, two years after the live virus Zostavax vaccine was licensed by the FDA for adults 60 and older.

Medical experts agree that the key to preventing shingles lies in vaccination. Shingrix, a recombinant zoster vaccine, was licensed by the FDA and recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) in late 2017 for adults aged 50 years or older. The ACIP’s stated preference for Shingrix came after the vaccine was shown to be up to 90% effective in clinical trials.

“I hope that with the strong ACIP recommendation and a new vaccine that appears to be highly effective that more people will recognize that there are really effective tools out there to help protect them from this disease which can be not only uncomfortable and cause harm in the short term, but the after effects of which may last years,” medical epidemiologist Kathleen Dooling, MD, MPH, and medical officer at the CDC’s Division of Viral Diseases told Drug Topics.

Oaklander concurs, adding that people eligible for the vaccine should be encouraged to think of vaccination as an insurance policy. “Get the vaccine now while your immune system is healthy and can mount a defense,” she tells them. “The problem is that if you wait until your immune system is already beaten up by your illness, the vaccine may not be as effective.”