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Shingles, Postherpetic Neuralgia, and How Telehealth Can Help

Shingles is a painful condition caused by the herpes zoster virus. When someone contracts chickenpox, the herpes zoster virus remains in the body’s neural network. During years, it may be “dormant,” which means there is no active rash or illness. Later on, however, a shingles rash with blisters appears on the chest wall or other parts of the body (Mayo Clinic, 2013).


Postherpetic neuralgia (PHN) is a complication of shingles. While many cases of shingles resolve within a few weeks, some people have prolonged symptoms, particularly pain. This occurs when the virus affects your nerve fibers and skin, causing a burning sensation that interferes with appetite and sleep. PHN is more common among older adults, especial those over the age of 60 years. When shingles occurs on the face, the chance of developing PHN is significantly higher than if it occurs on the chest or extremities.


At the present time, there is no cure for postherpetic neuralgia. However, there are some treatment options that relieve your symptoms. Most signs and symptoms are typically limited to the area where the shingles first occurred. These include burning or stabbing pain, itching, numbness, weakness, or paralysis. PHN occurs when nerve fibers are damaged during the initial shingles outbreak. These damaged fibers cannot send messages from your skin to your brain as they should. Instead, the messages get exaggerated, causing aggravating, chronic pain that could persist for years (Mayo Clinic, 2013).


Study Shows Lidocaine Better than New Drug KAI for Postherpetic Neuralgia


Researchers Dr. Cousins and colleagues (2013) studied the safety and efficacy of a new therapy called KAI-168. This is an epsilon protein kinase C (ePKC) inhibitor. When compared to lidocaine and placebo, they found that KAI could be safe, but not useful for treating postherpetic neuralgia. However, lidocaine was discovered to benefit patients with pain related to this condition.


Experts estimate that around 15 percent of patients who have herpes zoster eventually go on to develop postherpetic neuralgia. The researchers evaluated the analgesic properties of the ePKC inhibitor and discovered that it was not as effective as other options. However, it was safe and well-tolerated among patients.


The study was done during three different treatment periods. The 23 patients received subcutaneous KAI at 25 mg, a placebo solution, or lidocaine hydrochloride 700 mg during each treatment session. The investigators concluded that lidocaine was a more effective treatment for postherpetic neuralgia than KAI. This is why so many doctors today use topical lidocaine patches to treat this form of shingles.


Researchers Uncover Cause of Postherpetic Neuralgia Symptoms


Dr. Oaklander and colleagues (2008) recently studied postherpetic neuralgia pain mechanisms. In these studies, spontaneous C-nociceptor activity was documented in patients with this condition. In a skin biopsy study, researchers found that PHN affected nerves and ganglia due to chronic neuronal loss and quiescent scarring. Microneurographic studies correlated these findings, as well.


Pathological studies of tissues from patients with trigeminal neuralgia (a form of PHN) showed that brief lancinating pains reflect neurotransmission between adjacent axons. The chronic pain mechanism remains uncertain, however. Oaklander and associates believe that the itching is caused by unprovoked firing of the peripheral and/or central neurons.


Lidocaine Patch Location Influences Effectiveness in those with PHN


Shingles researchers Nalamachu and associates (2013) found that the anatomic location of the lidocaine patch contributed to effectiveness and tolerability for patients with postherpetic neuralgia. The 5% patch is considered first line therapy for patients with PHN.


An analysis was conducted to determine whether or not the location of the patch mattered. Placement occurred over portions of the neck, trunk, and extremities during a four week study. Effectiveness was measure with the Brief Pain Inventory (BPI) survey, and tolerability was evaluated based on patient reporting. The researchers concluded that the 5% topical lidocaine patch was generally well-tolerated and effective for each anatomic region.


Telehealth Efficient and Effective for Older Adults with PHN or other Chronic Conditions
If you think you have shingles or if you have postherpetic neuralgia, consider consulting the services of an online doctor. The virtual healthcare provider can issue you an online prescription so you do not have to travel for the visit.


Telehealth researchers Gellis and colleagues (2012) evaluated the use of telemedicine services for homebound older adults in a randomized controlled clinical trial. This form of healthcare delivery is emerging as a viable intervention to treat chronic conditions in older people, such as PHN, heart failure, and chronic lung disease. To engage older adults in self-care management of their conditions, researchers believe that telehealth is the answer.


Random effects were evaluated on health, mental health, and service utilization outcomes among homebound medically ill older adults. After a 12 month study, the telehealth intervention group reported greater increases in general health and social functioning compared to the control group who had more emergency department visits.


The implications of this report are that telehealth is an effective and efficient method of systematically delivering care to homebound older people. The use of this technology benefits people who have difficulty accessing health care due to transportation issues, isolation, or disability.

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