From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Herpes zoster: Shingles
Date: 19 Jun 1997
Newsgroups: sci.med

In <866599015.13154@dejanews.com> magi@empireone.net writes:
>
>My dad who is 87 has recently been afflicted with shingles.  I am
>wondering why older adults seem to get this.  His sister who is older also
>had shingles and it never cleared up.  She suffered pain for several
>years and he wants to know if that is what he can expect?  Can someone
>tell me why older folks get this and what are the usual treatments?  I
>found an article that says that it generally clears up in a month, but
>that was not true for my aunt and for another older person I know. I'd
>appreciate any information.  Thank you.


   It may have to do with loss of immune function as people age.  Or
perhaps lose of immunity to Herpes zoster-varicella with time, since
chickenpox was first contracted.  Or some combination.  Whatever the
case, the older you are when you get shingles, the more likely you are
to suffer post-herpetic neuralgia, which is a kind of nerve related
pain that comes from nerve damage during the viral outbreak.
Apparently the virus is gone, but the pain remains.

   Useful treatments for this include Zostrix HP (an over the counter
capsaicin creme), which has a hot pepper chemical that depletes nerves
of pain producing chemicals.  It has to be used on the effected area
several times a day without fail to have effect.

   Another useful treatment in my practice has been gabapentin
(Neurontin) a seizure drug often used by neurologists for nerve pain.
This stuff produces drowsiness, but it's VERY useful for night-time
nerve pain syndromes of all kinds.  The elderly sometimes cannot
tolerate it because of confusion and sleepiness, but many can.  The
trick is finding the right dose.  You start with one 100 mg capsule at
bedtime, and work your way up in dose.

   A nasal form of calcitonin (Miacalcin) is used to prevent and treat
osteoporosis, but has the "side effect" of also being a nerve pain
blocker.  This stuff is therefore useful in people who have causalgia/
neuralgia, phantom limb pain, and so on.  And it helps bone pain of all
kinds (including osteoporotic fracture pain).  It's again particularly
good in the elderly, because many of them have a need for it from the
osteoporosis standpoint, so you get two effects for the price of one.

                                          Steve Harris, M.D.