(Health Times reporter Kong Tianjiao Zhang Shuang) waist as if burned by fire, sitting as if something is tearing, sleeping like being electrocuted or knife...... The pain caused by shingles is always sudden and easy to prolong.
Herpes zoster is a common infectious skin disease that can occur at any age, mostly in middle-aged and elderly people over 50 years old and people with compromised immune systems. Once shingles is diagnosed, early, adequate antiviral therapy, as well as ongoing management of shingles-related pain, are crucial.
Herpes zoster can occur at any age, and its incidence increases with age
Liu Liangkun (not his real name), who lives in Beijing, contracted shingles five years ago. "I remember, in 2019, I was lying on the sofa reading a book, and when I sat up, the clothes on my waist rubbed against the sofa, causing a slight friction pain, I opened my clothes to look, and found a few red spots, I didn't pay attention to it at the time, and when I took a shower at night, I took a special look and found that there were already three blisters the size of mung beans on my waist." Liu Liangkun recalled to the Health Times reporter that five years ago, when he had just celebrated his 60th birthday.
"Because my sister had this disease and had a certain understanding of shingles, so when my family found out about my condition, they suspected that it was also shingles, so I hurried to the hospital." Liu Liangkun told reporters that after he arrived at the hospital, the doctor diagnosed herpes zoster and treated it.
On July 11, Zhao Ying, chief physician of the pain department of Beijing Hospital, treated patients with postherpetic neuralgia. Photo by Zhang Shuang
Herpes zoster is an infectious skin disease caused by the reactivation of varicella-zoster virus infection. According to Zhao Ying, chief physician of the pain department of Beijing Hospital, shingles often occurs in the waist and abdomen, chest and back, neck, head and face. In addition to symptoms such as fatigue, low-grade fever, and a burning sensation on the affected skin, the main manifestations are neuralgia and skin breakage, as Liu Liangkun mentioned, the pain began on the night after the blisters appeared.
The Chinese Expert Consensus on Herpes Zoster (2022), published in the Chinese Journal of Dermatology in 2022, mentioned that there are more than 1.5 million new cases of herpes zoster in people aged 50 and above in mainland China every year. Cui Yong, Vice President and Director of the Department of Dermatology of the China-Japan Friendship Hospital, said: "Generally speaking, the incidence of herpes zoster is mostly middle-aged and elderly people over 50 years old, mainly because with age, the body's immune system function gradually declines, resulting in the reactivation of the latent varicella-zoster virus in the elderly. ”
Cui Yong reminded that although shingles mainly affects the elderly, it can also occur at any age, and the incidence increases significantly with age. In addition, shingles can also occur in people with compromised or immunocompromised immune systems, such as HIV infection or AIDS, malignancies, and patients using immunosuppressive drugs or chemotherapy drugs.
In Zhao Ying's outpatient clinics in the past two years, the proportion of middle-aged patients over the age of 40 has also increased significantly. "With the acceleration of the pace of society, people stay up late for a long time, work under excessive pressure, and mental tension, which will make the body overtired, resulting in low immunity, and then inducing the occurrence of shingles." Zhao Ying explained to a reporter from the Health Times.
44-year-old Li Jin (pseudonym) is a programmer who often works overtime late into the night due to his heavy daily tasks. "After a continuous overtime, I felt a slight pain in my lower back on the left side." Li Jin told the Health Times reporter that at first, he thought it was just muscle pain caused by sitting for a long time, however, the pain got worse day by day, and erythema and blisters along the nerve appeared. "After going to the hospital, the doctor quickly diagnosed shingles."
It hurts so much that you can't sleep, and some of the pain can last for months or even decades
Shingles-related pain is the most important complication of shingles, which bothers almost all patients with shingles. According to the Chinese Expert Consensus on the Diagnosis and Treatment of Postherpetic Neuralgia published by the Chinese Journal of Pain Medicine in 2016, about 9%~34% of patients with herpes zoster will develop postherpetic neuralgia. The incidence and prevalence of postherpetic neuralgia gradually increase with age, and about 65% of patients with herpes zoster aged 60 and above will develop postherpetic neuralgia, and the incidence of postherpetic neuralgia over 70 years old can reach 75%.
Although the skin lesions of Liu Liangkun's shingles have healed, the pain hidden under the skin has not disappeared, and postherpetic neuralgia has been with Liu Liangkun for the past 5 years.
In less than three months, Liu Liangkun lost 20 pounds of weight rapidly because of postherpes zoster neuralgia.
"At first, I couldn't sleep every night, mainly because of the pain, the pain in my heart, and I repeatedly turned over and found the best position to lie on my side to barely sleep for a while. After my sleep quality decreased significantly, my diet also began to decrease, and I was able to eat two bowls of noodles at one meal before I got sick, and I was reluctant to eat a small bowl after I got sick. ”
Herpes zoster-related pain includes acute phase pain and postherpetic neuralgia, where acute phase pain mainly refers to nociceptive pain caused by local inflammation, while postherpetic neuralgia is neuropathic pain, which is caused by various mechanisms of neuropathy itself, so it can still exist one month after the rash has healed, and even last longer, up to months or years. "In the outpatient clinic, we have also seen patients who have been in pain for 10 years." Cui Yong told reporters.
Cui Yong, Vice President of China-Japan Friendship Hospital and Director of the Department of Dermatology. Photo courtesy of the interviewee.
At Zhao's pain clinic, half of the patients seen were associated with shingles. Although the intense pain caused by shingles can reach 10 (7~8 pain in childbirth), Zhao Ying told the Health Times reporter that this pain also varies from person to person: "Half of the patients have severe pain and are unbearable, and some patients only have mild itching. If a patient with an underlying medical condition such as diabetes suffers from herpes zoster again, the pain will be more severe because diabetic peripheral neuralgia and postherpetic neuralgia are caused by peripheral nerve damage. ”
Due to its long duration, this pain can not only affect the patient's sleep, mood, but also all aspects of work and daily life, causing serious consequences for quality of life.
After Li Jin, who works in Wuhan, Hubei Province, was diagnosed with shingles in June, doctors prescribed him antiviral drugs and painkillers, and advised him to adjust his work habits and ensure adequate rest.
A week later, Li Jin's skin symptoms were controlled, but because he did not fully follow the doctor's instructions to rest, Li Jin's neuralgia has not subsided until now, and he cannot return to normal work.
Dermatology and pain can be treated, and it is necessary to see a doctor within 3 days of the "golden hour".
Cui Yong reminded that after the diagnosis of herpes zoster, it is very important to use antiviral drugs as soon as possible, and the use of antiviral drugs in an early, sufficient amount and full course of treatment can quickly control symptoms, effectively shorten the course of the disease, and improve symptoms in time to reduce the occurrence of posterior neuralgia. If the drug is reused more than 72 hours after the onset of the disease, the effect will be greatly reduced, and the management of shingles-related pain must be highly concerned throughout the process. Therefore, when considering a suspicious herpes zoster rash, it is important to come to the hospital in time.
Zhao Ying explained to the Health Times reporter that whether it is dermatology or pain, shingles can be treated, and patients do not need to be too entangled in this. If the patient has a high need for local skin lesion treatment, or if the pain is severe, local treatment in combination with pain medicine can be used to achieve better treatment results. In addition, in terms of antiviral, anti-inflammatory, and analgesic, the two departments of dermatology and pain have the same medication and treatment ideas, and patients can choose according to their own conditions.
At present, the treatment of herpes zoster mainly adopts basic treatment, antiviral therapy and pain management. Zhao Ying told the Health Times reporter that commonly used antiviral drugs include acyclovir, valacyclovir and famciclovir, which can inhibit viral replication, reduce symptoms, and reduce the risk of postherpetic neuralgia, but they should be started within 72 hours of the onset of the rash, and most of these drugs have been included in the national medical insurance list, so patients should not delay treatment because of the cost.
In addition, for refractory herpetic neuralgia and postherpetic neuralgia, interventional treatments such as nerve block therapy in the painful area, selective nerve destruction, intrathecal drug therapy, and neuromodulation techniques can be used to achieve the purpose of pain treatment.
Zhao Ying specially reminded: "The disappearance of skin lesion symptoms does not mean that it has been cured, and patients must not stop treatment on their own. Adequate and adequate antiviral therapy and effective local treatment of herpes can effectively reduce the probability of symptoms such as postherpetic neuralgia. ”
Zhao Ying found that if patients can receive antiviral treatment in time in the acute stage of herpes zoster and maintain an optimistic and positive attitude, it will also promote the recovery of the disease.
Zhao Ying once treated an 80-year-old patient, and the optimistic and positive attitude of the old man left a deep impression on Zhao Ying: "After the old man found that he had blisters on his waist, he came to the hospital as soon as possible. Whether it is infusions or injections, as well as local physiotherapy and nerve block treatment, she is very cooperative, happy every day, and her attitude is very optimistic. "After a course of treatment, the patient's condition improved quickly.
Although there are a variety of clinical means to effectively intervene in the symptoms related to herpes zoster, Zhao Ying still recommends that people over 50 years old who are eligible for vaccination should be vaccinated against herpes zoster in time. "As we age, our immunity gradually declines, and even if we have had shingles before, a small number of patients may relapse. Vaccination can effectively prevent the occurrence or recurrence of herpes zoster, reduce the severity of herpes zoster and the risk of postherpetic neuralgia. ”
In addition, it is also important to maintain a healthy lifestyle, such as regular work and rest, a balanced diet, moderate exercise, and avoiding excessive stress, all of which can help strengthen immunity.
Cui Yong reminded: "The elderly, children, pregnant women and people with low immunity should pay attention to avoid close contact with patients with shingles as much as possible, especially do not touch the rash with blisters on the patients. Once you have symptoms that are suspected of shingles, you should seek medical attention in time to avoid worsening the condition. ”