Close-ups

A Patient's Perspective

Coping with the Pain

It started with pain in the right side of my face. It felt like it was in my jaw going up to my right ear. Then, a half-hour later, I was brushing my hair and saw six or seven little red blisters on my forehead. They were unusual, a triangle-shaped cluster. I wondered what they were. By the end of the day, the pain was really bad and painkillers were not touching it. It felt like someone was jabbing a knife into my head every two seconds. I was in tears, the pain was so bad. Learning that I had shingles didn't do a lot to reassure me. I remembered that my uncle, who is a physician, was in the hospital with shingles for a month. He was on morphine and everything else-nothing worked.

I would say I had two solid weeks of terrible pain. Knifelike pain shot into my head every few seconds, 24 hours a day. Then, gradually, the pain came less often-still as severe, but coming only every hour or so. The rash spread down my forehead to my eyebrow and down to my eyelid. It went over my temple and the whole right side under my hair. It was just horrible. Luckily, it hadn't damaged my eye.

I was completely locked away. I had to cancel my plans to go to my 40th high school reunion. I even had to cancel our annual family get-together because we have a lot of little kids and my mother is 81 years old-I couldn't expose anyone to this.

I still occasionally get headaches. That's how I know I still have the virus. I attribute the relapses to stress. I've started yoga. They said I was at high risk for postherpetic neuralgia because of how long this took to go away.-l.e., 57

COMMENTARY

L.E.'s story makes a good case for the vaccine to prevent or diminish the effects of post-herpetic neuralgia. The zoster vaccine reduced the incidences of postherpetic neuralgia (66.5 percent reduction) and herpes zoster (51.3 percent reduction).1 The Advisory Committee on Immunization Practices recommends the vaccine in persons 60 years or older. Early treatment of shingles with anti-viral agents can also help decrease the incidence and intensity of postherpetic neuralgia.

caroline wellbery, md

REFERENCE

1. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005;352:2271-84.

RESOURCES

National Institute of Neurologic Disorders and Stroke, "Shingles: hope through research" (especially, "Is shingles contagious?" section)

Web site: http://www.ninds.nih.gov/disorders/shingles/detail_shingles.htm

Centers for Disease Control and Prevention:

Vaccines & immunizations
Web site: http://www.cdc.gov/vaccines/vpd-vac/shingles/default.htm

News on shingles vaccine
Web site: http://www.cdc.gov/vaccines/vpd-vac/shingles/vac-faqs.htm

General questions about shingles

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors. Submit patient scenarios via e-mail to afpjournal@georgetown.edu with the heading: Close-ups submission [your last name].

Submissions must include a patient story, commentary, patient photograph, resources, signed patient release form, and author statement form. Photographs must meet minimum quality standards (see Authors' Guide for more information).

Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD, Tony Miksanek, MD, and Jo-Marie Reilly, MD. Questions about this department may be sent to Dr. Wellbery at wellberc@georgetown.edu.