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Transcript – Programme 46: Post-Herpetic Neuralgia and Migraine

Bust­ing some myths about shin­gles and post-her­pet­ic neu­ral­gia, and the dos and don’ts of man­ag­ing migraines

To lis­ten to this pro­gramme, please click here.

Migraine is not ‘just a headache’ – it’s a dis­abling con­di­tion that can cause major dis­rup­tion to work and per­son­al life. So says David Wat­son, a GP who spe­cialis­es in treat­ing patients with chron­ic headaches. He explains that the ‘migraine brain’ is extra sen­si­tive to changes in the envi­ron­ment, how small changes in lifestyle can help peo­ple min­imise episodes and how to avoid the pit­fall of med­ica­tion overuse. Dr Wat­son also gives help­ful advice on how patients with migraine can best pre­pare for a vis­it to their GP.

Post-her­pet­ic neu­ral­gia is anoth­er fre­quent­ly mis­un­der­stood con­di­tion with myths about its con­ta­gious­ness and rela­tion­ship to chick­en­pox and shin­gles caus­ing con­fu­sion. Mar­i­an Nichol­son of the Shin­gles Sup­port Soci­ety clears up these mis­un­der­stand­ings and empha­sis­es the impor­tance of pre­ven­ta­tive treat­ments. We also hear about a new vac­cine which should help to pro­tect old­er peo­ple who are most at risk of devel­op­ing post-her­pet­ic neu­ral­gia after shingles.

Issues cov­ered in this pro­gramme include: Post-her­pet­ic neu­ral­gia, migraine, headaches, hyper­sen­si­tiv­i­ty, lifestyle, mis­con­cep­tions, pre­ven­ta­tive treat­ment, vac­cine, shin­gles, elder­ly peo­ple, trig­gers, burn­ing sen­sa­tion, chick­en­pox virus, drugs, med­ica­tion, painkillers, antivi­ral med­i­cine, nerve pain, tri­cyclic anti­de­pres­sant and antiepileptics.

Paul Evans: I’m Paul Evans and wel­come to Air­ing Pain, a pro­gramme brought to you by Pain Con­cern, the UK char­i­ty pro­vid­ing infor­ma­tion and sup­port for those of us liv­ing with pain. This edi­tion has been fund­ed by a grant from The Scot­tish Government.

David Wat­son: If you look at pop­u­la­tion stud­ies of peo­ple with chron­ic headache, any­thing up to 20–30% of patients are overus­ing painkillers and if you look at spe­cif­ic clin­ic based stud­ies of patients who have been referred by a GP to a spe­cial­ist, any­thing up to 70% of those patients overuse medication.

Mar­i­on Nichol­son: The nerve that the virus used to trav­el to the skin sur­face by, has been dam­aged by the virus trav­el­ling along the nerve and it car­ries on send­ing these pain mes­sages to your brain and that’s what peo­ple talk about when they say they’ve got shin­gles months lat­er, it’s not shin­gles – it’s now called post-her­pet­ic neuralgia.

Evans: In this edi­tion of Air­ing Pain we’re look­ing at two con­di­tions that can have a major bear­ing on how we live our lives. One deriv­ing from a virus that near­ly all of us have car­ried since child­hood and the oth­er is headache. David Wat­son is a GP in Aberdeen with a long­stand­ing inter­est in headache as well as his gen­er­al prac­tice; he joint­ly runs a headache clin­ic in the Depart­ment of Neu­rol­o­gy, Aberdeen Roy­al Infir­mary. He was also involved in devel­op­ing headache guide­lines and stan­dards at a nation­al lev­el in Scot­land. Now we all get headaches, so shouldn’t we just put up with them?

Wat­son: Ten­sion headaches are prob­a­bly the com­mon­est headaches that any­one can get but ten­sion headaches are non-dis­abling headaches, if you’ve had a bad day at work or you’re a bit tired and you should prob­a­bly go out and get some fresh air or go for a walk, maybe take a parac­eta­mol, but migraine on the oth­er hand is a dis­abling headache. It prob­a­bly affects up to 6 or 7 mil­lion peo­ple in the UK and migraine by def­i­n­i­tion is a headache that is worse with activ­i­ty. If you say to some­one who gets migraine ‘what do you do when you have a migraine?’ very often they feel they need to stop activ­i­ties. Inter­est­ing­ly, the World Health Organ­i­sa­tion would put migraine in its top 20 dis­abling con­di­tions and in fact, in women, in its top 12 dis­abling con­di­tions. If you can imag­ine that migraines are mod­er­ate to severe headaches that are made worse by move­ment, some peo­ple feel squea­mish or sick with it and oth­er peo­ple find that they are very sen­si­tive to the room, whether it be noise or light or smells, and if you get one of those very bad migraine episodes then prob­a­bly you’re going to be sit­ting in a dark room or even lying down, and because of that you are not able to do activ­i­ties. So I think we need to take migraine very seri­ous­ly cause it’s prob­a­bly one of the com­mon­est caus­es, for exam­ple, of short-term sick­ness absences in the UK and they reck­on it prob­a­bly costs a cou­ple of bil­lion pounds a year in lost rev­enues to the econ­o­my, and for the suf­fer­er it’s very dif­fi­cult. A lot of peo­ple get migraine very often and live in fear of their next migraine. It’s a bit like the weath­er and wed­dings: it’s not in any way planned and peo­ple live in fear and dread about hav­ing to can­cel activ­i­ties like meet­ing a friend, going to the cin­e­ma, going out with their part­ner. Inter­est­ing­ly, if you speak to the part­ners of peo­ple with migraine, they’ve had sit­u­a­tions where it’s them that have gone to the par­ty and part­ners have been left at home, for example.

Evans: I can vouch for that!

Wat­son: I have been in that sit­u­a­tion as well, my wife, my moth­er-in-law and my daugh­ter all get migraine and I’m very lucky, I prob­a­bly only get about four migraines a year and it’s my way of the body just say­ing slow down and you’ve got to get some prop­er rest. I remem­ber before I got mine, meet­ing my wife in Ams­ter­dam and it was all com­mo­tion and song, a lost week­end in a hotel in Ams­ter­dam with my poor wife lying there with her migraine and I was think­ing ‘do I sit in the hotel room all week­end with her or do I go out and see all the sites of Ams­ter­dam’ [laughs] so yes it is incred­i­bly dis­abling, not just for the patient, but for fam­i­ly mem­bers as well.

Evans: We’re laugh­ing about it now but it real­ly is a seri­ous prob­lem for people.

Wat­son: I think the sin­gle biggest dif­fi­cul­ty for peo­ple with migraine is peo­ple who don’t get migraine call­ing it just a headache. I think for some­one who gets dis­abling migraine, you know for exam­ple, they phone in to the boss in the morn­ing and say ‘I’m very sor­ry I have a bad migraine today’ there is a bit of ‘what do you mean you can’t come in! It’s only a headache!’ and this poor per­son is lying in a dark room with a sick buck­et by their bed, dar­ing not to move because the pain is so severe. So, yes, I laugh about being in that sit­u­a­tion, a headache doc­tor with my wife hav­ing migraine, but it is incred­i­bly disabling.

Evans: You say you get a cou­ple of migraines a year, do you know what caus­es those?

Wat­son: We don’t know what caus­es migraine. So when I see patients and they say ‘can I have a cure’ and I have to explain that we don’t know the cause so we can’t give a cure. But what we know that the migraine brain is sen­si­tive to the envi­ron­ment whether it is to our inter­nal envi­ron­ment or exter­nal envi­ron­ment. It’s almost like there’s a switch in the bot­tom of the brain and when it gets switched on you get this wave of ener­gy going across the brain set­ting off the chem­i­cal changes that then result in all the migraine symp­toms. In a sense, how often you get your migraine is set by how sen­si­tive the genes you have inher­it­ed have set that switch. So I’m lucky that it takes quite a lot to set me over that thresh­old and the migraine brain likes reg­u­lar­i­ty, you know, it likes reg­u­lar meals, reg­u­lar sleep, reg­u­lar exer­cise. It’s much more com­mon in ladies because of hor­mon­al changes, that’s why three times more ladies get migraines. So that’s a sort of inter­nal envi­ron­ment. Then there’s the exter­nal envi­ron­ment, some patients will have spe­cif­ic foods or smells. A col­league, for exam­ple, for who a par­tic­u­lar per­fume will set him off – he remem­bers being in a lift to a meet­ing once and get­ting a migraine after stand­ing close to a cou­ple of ladies who had this par­tic­u­lar per­fume on that set him off. Some migraine suf­fer­ers, for exam­ple, can pre­dict weath­er changes, they feel that atmos­pher­ic pres­sure change. I know in my case it’s burn­ing the can­dle at both ends, try­ing to do too much, maybe rush­ing around at work and not drink­ing enough flu­ids dur­ing the day, miss­ing lunch because I’ve had to go to a meet­ing or what­ev­er it might be, and it’s almost like the brains get­ting wound up and wound up and wound up and then you get that release of pain. I’m prob­a­bly quite lucky that my headaches aren’t extreme­ly painful but I get all the non-recog­nised symp­toms, I’m a bit clum­sy, my speech isn’t quite as clear, my brain goes into this like fog and I know that I prob­a­bly need two or three nights of prop­er sleep and eat­ing at the right time, drink­ing plen­ty of flu­ids. So we know for patients that a com­bi­na­tion of these fac­tors will bring on a migraine for them. We see a lot of patients at the clin­ic who have what we call chron­ic migraine. Now chron­ic in headache terms sim­ply means headache for 15 or more days a month. So, most patients with migraine will get one or two migraines a month that might last a day or two days, fair­ly dis­abling for that patient. But there are patients that get headaches a lot of the time, cer­tain­ly more than half the month and if eight of those days are migraines then we call that chron­ic migraine. It’s inevitable that most of the peo­ple I see at the clin­ic with chron­ic migraine are ladies in their late 30s, into their 40s and they are very like­ly start­ing to become slight­ly per­i­menopausal so hor­mon­al lev­els are just start­ing to go up and down. But they tend to be busy peo­ple, they’re work­ing full time, they’ve got chil­dren, they’re run­ning a house­hold, they are part of the par­ents asso­ci­a­tion, they are help­ing out with Scouts on the week­ends or at the church or what­ev­er, and very often not get­ting prop­er reg­u­lar sleep. They’re not get­ting any time to them­selves and real­ly in a sense their brain is nev­er get­ting a chance to switch off. I very often say to these ladies ‘well we can try you with some med­i­cine or a tablet but I’m going to give you some home­work and that home­work is that I want you to find a time each day that is your time to try and switch the brain off’. Now I can’t tell you how to switch your brain off, for some peo­ple it may be to shut the bath­room door, a hot bath and a book, for oth­ers it might be going out for a walk, but it’s impor­tant for migraine suf­fer­ers to give their brain some down time just to give it this kind of unwind time to relax it.

Evans: And this isn’t a self-inflict­ed thing, it’s a gen­uine ill­ness, it is not some­thing that you’re putting on yourself.

Wat­son: Absolute­ly not! Peo­ple with migraine have the genes that make them more sen­si­tive to what hap­pens either inside the body or out­side the body. Some­one who doesn’t have migraine will do the same and not get headaches. Unfor­tu­nate­ly for the patient who gets migraine the brain needs that kind of switch off time. And I think it’s for peo­ple to try and recog­nise that in them­selves. I’ve seen patients that have come back to me and have said they have man­aged to get reg­u­lar sleep and [are] mak­ing sure they don’t miss break­fast and are bet­ter at drink­ing flu­ids and [they] do as [I] told [them] and [they] get migraine now and then but [they are] not get­ting so many. I saw a lady in the clin­ic the oth­er day who works in the bak­ery at Tesco, I said ‘it’s a hot place, do you drink any flu­id?’ ‘Oh no, I don’t drink at all when I’m at work’ and I said ‘what about at lunch?’ ‘Oh well I cut my lunch short and get away ear­ly so I can pick the chil­dren up from school’ and when I saw her again she was much, much bet­ter and prob­a­bly the med­i­cine helped a bit, but she said ‘I actu­al­ly go out of Tesco and go for a 20 minute walk at lunch time and I make sure I’m drink­ing plen­ty’ and it’s nice to think that a small change for some peo­ple can make a difference.

Evans: It’s inter­est­ing that what to many peo­ple sounds like com­mon sense: that if you do work through your lunch, if you don’t drink all day, well you would think that it would have an effect on you, but to be told that by a doc­tor then it’s OK.

Wat­son: I think some­times, with my GP hat on, a lot of what I do some­times is to try and put things into per­spec­tive for peo­ple or even kind of nor­malise things a lit­tle bit. Don’t get me wrong, for a lot of peo­ple, look­ing at lifestyle isn’t the whole answer for migraine and they‘ve got this con­di­tion and they need med­ica­tion as well. But I think some­times peo­ple kind of get onto the ham­ster wheel a lit­tle bit and kind of need per­mis­sion to get off that ham­ster wheel now and then.

Evans: You men­tioned ear­li­er that most patient’s expe­ri­ences with deal­ing with their headaches is by going to the phar­ma­cist and get­ting parac­eta­mol and what­ev­er else is on the shelf, is this a good practice?

Wat­son: Patients who get a bad headache or a migraine every now and then, I think it’s absolute­ly fine to self-man­age, in fact a lot of the guide­lines say that tak­ing aspirin or ibupro­fen is as good as the more spe­cif­ic migraine tablets. The dif­fi­cul­ty is for patients who start to get more fre­quent migraine and we know that if you start hav­ing to take painkillers on a more reg­u­lar basis, for some patients, painkillers will actu­al­ly cause headache and we would prob­a­bly say that patients would need to restrict painkillers to no more than two days a week, and unfor­tu­nate­ly med­i­cines with codeine in them tend to be the biggest cul­prits for headache caused by painkillers and that’s in things like Sol­padeine and Migraleve and Co-codamal and Co-dydramol, you know very com­mon painkillers.

Evans: So you’re say­ing that overuse of these can actu­al­ly cause the headaches?

Wat­son: Absolute­ly! Absolute­ly! So if you look at peo­ple who trans­form from an episod­ic migraine, now and then, to this chron­ic headache over half the month, a large fac­tor in that for some patients is the overuse of painkillers. Now, the dif­fi­cul­ty is that when you stop the painkillers not every­one gets bet­ter, but cer­tain­ly in our clin­ic in Aberdeen prob­a­bly in 10 patients overus­ing painkillers and you stop those painkillers, with­in about 4 weeks prob­a­bly 6 out of 10 patients will be a lot bet­ter, not cured of migraine, they would still get their headache but it would be back to every now and then. But the four patients, where stop­ping the med­i­cines didn’t help in terms of headache fre­quen­cy, what we do know is that the pre­vent­ed treat­ments will work bet­ter if the overused med­i­cine is not there. And if you look at pop­u­la­tion stud­ies of peo­ple with chron­ic headache, any­thing up to 20 or 30% of patients are overus­ing painkillers and if you look at spe­cif­ic clin­ic based stud­ies of patients who have been referred by GP to a spe­cial­ist, any­thing up to 70% of those patients overuse med­ica­tion. It’s a per­fect­ly under­stand­able thing, if you’ve got pain you take a painkiller and you have patients who say ‘well I have to take some­thing when I wake up to get me through the day’. I think it’s dif­fi­cult for these peo­ple because when you stop a painkiller the headache will get worse for the first week to 10 days whilst the medicine’s com­ing out of the sys­tem and that’s why it’s real­ly impor­tant to have a part­ner­ship with the patient.

Evans: What would your advice be to some­body who is suf­fer­ing headaches? How should they talk to a health professional?

Wat­son: That’s a good ques­tion. I think a lot of patients find it dif­fi­cult to express the dis­abil­i­ty they get with espe­cial­ly migraine and they some­times find it dif­fi­cult to express the oth­er symp­toms that they get. It nev­er sur­pris­es me that headache doc­tors have a smile when patients come to see us and they’ve been referred, for exam­ple, with a headache that they’ve had for 2–3 months. I will say to them that ‘we need to talk about that headache’ but I need to know about oth­er headaches you’ve had in the past and they say ‘Oh, I just get nor­mal headaches’ and we smile because most peo­ples’ nor­mal headaches are migraine and I say ‘can you explain what you mean by nor­mal headache?’ they say ‘Oh well, you know, I get this headache and feel quite sick and have to go and lie down’ you then might explore that more with them and ladies will say ‘Oh yes, it’s a headache I got with my peri­od’ and when you say to the patient ‘well that’s actu­al­ly migraine’ and they say ‘Oh, no one’s ever told me that I have migraine.’ So patients may nat­u­ral­ly play symp­toms down and I think that’s dif­fi­cult for patients to try to under­stand, but you can’t expect patients to know how to make a diag­no­sis. What will be use­ful for patients is to think of all the ways that headache affects them because what I say to GPs is that if you’ve got some­one that comes in with a headache that’s episod­ic, in oth­er words they get a headache for a day or two and then they’re bet­ter for a cou­ple of weeks and then they get a headache for a day or two and that headache is asso­ci­at­ed with some dis­abil­i­ty so the patients maybe want to stop activ­i­ties and they maybe feel a bit sick and they don’t like light, then those are kind of the trig­ger to say this is going to be migraine.

Most peo­ple try and keep going so they don’t think of them­selves as being dis­abled and again when I teach the med­ical stu­dents I say, if you say to a mum with three kids under five and she gets migraine ‘Do you go and lie down?’ She’s going to look at you as if to say ‘Well of course I don’t go and lie down’ or some­one who’s got a dif­fi­cult job and the boss is a bit dif­fi­cult and you say ‘Do you go home when you get a migraine?’ They say ‘Well no, I just keep going’. So you have to phrase the ques­tion for exam­ple, ‘If your hus­band is home on the week­end and you got a migraine what would you do?’ ‘Oh, I’ll go and lie down’. So I think what’s good for patients is before they see a doc­tor about headache is to think about how that headache impacts on their life and if they think that this headache is stop­ping [them] doing things or its pre­vent­ing [them] doing things prop­er­ly, in oth­er words, [they] keep going but it’s a strug­gle. Then it [can be dif­fi­cult] to try and talk to the GP about that because what very often doc­tors focus on, if they don’t real­ly under­stand migraine, is where is the pain, which bit of your head and is it sharp pain or a throb­bing pain or a dull pain and so patients get side­tracked describ­ing the pain. Where­as migraine can be any kind of headache, any­where on the head and the key is real­ly more to what the oth­er symp­toms are. We have devel­oped, in Aberdeen, a ques­tion­naire that goes in a book­let out to patients just to say to patients ‘These are the sort of ques­tions that a doctor’s going to ask you, just have a wee think before you come to the clin­ic about how the headache affects you’.

Think­ing about it, if you come to the GP for exam­ple, and most patients with migraine will nev­er see a spe­cial­ist, it will prob­a­bly be only 1 in 100 patients with migraine will ever get referred to see a spe­cial­ist. So if you’re going to a doc­tor because you are get­ting bad headaches, don’t go in and talk about your child’s chick­en­pox or your gran’s demen­tia or prob­lems you get with your flat feet or what­ev­er, go in and make a headache con­sul­ta­tion so the GP has time just to talk about headache and go in think­ing about how does this headache affect me and how does it impact on my life and in that way you’re kind of prompt­ing the doc­tor to ask you the right questions.

Evans: I’ll just remind you that whilst we at Pain Con­cern believe the infor­ma­tion and the opin­ions on Air­ing Pain are accu­rate and sound based on the best judge­ments avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ter relat­ing to your health and well­be­ing. He or she is the only per­son who knows you and your cir­cum­stances and, there­fore, the appro­pri­ate action to take on your behalf. Now about 1 in 5 of us will have shin­gles in our life, most like­ly after we’ve past our 50th birth­day. Mar­i­on Nichol­son is the direc­tor of the Shin­gles Sup­port Society.

Nichol­son: Shin­gles is the name we give to a repeat appear­ance of the chick­en­pox virus. So what hap­pens is every­one gets chick­en­pox as a kid or near­ly every­one in this coun­try, it’s about 95%. Then at some point in the future, chick­en­pox virus can reap­pear, instead of com­ing out over your whole body what it does this time is just come out in a line per­haps around your ribs or side of your face, it’s always one side of the body only and it usu­al­ly starts with a nasty pain which often the patient doesn’t recog­nise, that’s one of the tricky things. They will say I thought I had pulled a mus­cle or I thought I was aller­gic to some­thing I used or I thought I had been bit­ten by an insect. And then after that pain, usu­al­ly after a cou­ple of days, and that’s when it gets diag­nosed. When the doc­tor can actu­al­ly see the spots, because before then the doc­tor will prob­a­bly agree that, yes, you have prob­a­bly pulled a mus­cle. That’s a both­er because the treat­ment for shin­gles needs to be start­ed with­in 3 days, there’s a 72-hour win­dow. Because, although the treat­ment could be giv­en after that time, it real­ly won’t have much effect. Shin­gles needs to be treat­ed ear­ly with the antivi­ral drugs.

Evans: Well I’ve known peo­ple who’ve had shin­gles, my own grand­moth­er includ­ed, who you say the treat­ment has to be start­ed with­in the 3 days, she must have had it for months and months and months.

Nichol­son: Right now you see that is no longer shin­gles. Shin­gles real­ly is the name that we give to the blis­ters that hap­pen and clear up usu­al­ly with­in 2 weeks, in the case of my nephew who’s 13 they cleared up in 3 days. Now what can hap­pen in old­er peo­ple par­tic­u­lar­ly, or in some very unlucky younger ones, is that after the shin­gles blis­ters go away the nerve that the virus used to trav­el to the skin sur­face by has been dam­aged by the virus trav­el­ling along the nerve and it car­ries on send­ing these pain mes­sages to your brain, and that’s what peo­ple talk about when they say they’ve got shin­gles months lat­er. It’s not shin­gles, it’s now called post-her­pet­ic neu­ral­gia. Neu­ral­gia mean­ing, it’s a pain cre­at­ed in the nerve. I often tell peo­ple that it’s a sort of ghost pain – in that, although the arm or the rib feels painful, there is actu­al­ly noth­ing wrong with that arm or that leg. It real­ly is that the nerve is send­ing a false mes­sage to the brain just as peo­ple who have had an ampu­tat­ed hand report that they still feel pain in that hand although that hand is no longer there. So it’s the nerve itself which is cre­at­ing this pain mes­sage and it’s very tricky to treat.

Evans: How do you stop the shin­gles becom­ing post-her­pet­ic pain?

Nichol­son: We don’t have any way of stop­ping shin­gles becom­ing post-her­pet­ic neu­ral­gia. Although one expert pain doc­tor does sug­gest that any­one who is 50 or old­er who devel­ops shin­gles, should imme­di­ate­ly be start­ed on one of the two main drugs that are used to con­trol this kind of pain. One is a tri-cyclic anti­de­pres­sant, the oth­er is an antiepilep­tic drug, orig­i­nal­ly, both of these drugs are used now, main­ly to treat this kind of pain, neu­ral­gia. His sug­ges­tion is that if you’re 50 when you devel­op shin­gles, the rash, you should imme­di­ate­ly be start­ed on this tri-cyclic anti­de­pres­sant because these two drugs, they are real­ly inter­est­ing, you know, they are not actu­al­ly pain relief in that they don’t actu­al­ly stop pain right away, the way aspirin or mor­phine would, what they do is slow­ly over time they build up a pain block, so day after day that you’re tak­ing these two drugs anoth­er brick is added to the wall of block­age and even­tu­al­ly after 3 weeks, or in some peo­ple 6 weeks, and with the dose increas­ing reg­u­lar­ly, every 10 days you would need to put the dose up again, your pain wall is high enough that the pain mes­sage no longer reach­es the brain and once that’s in place you can start reduc­ing the dosage of the tri-cyclic anti­de­pres­sant or the anti-epilep­tic drug and the pain block will hold even though you’re now reduc­ing the dosage.

Evans: You’ve just men­tioned the ill­ness, chick­en­pox; many peo­ple won’t asso­ciate the con­di­tion, shin­gles, with chickenpox.

Nichol­son: That’s right and one of the main con­cerns is when they phone the helpline of the Shin­gles Sup­port Soci­ety is ‘how have I caught this or who can I go vis­it, who can catch what from me?’ So, you start off by catch­ing chick­en­pox as a kid, it remains in your neur­al gan­glions those are nerve junc­tion box­es beside every spinal ver­te­brae in your body and then when it reac­ti­vates it is called shin­gles. Now you can only have shin­gles if you’ve had chick­en­pox, nobody can catch shin­gles, it is always some­thing that just devel­ops because you have had chick­en­pox in the past, and shin­gles is only trans­mit­ted to anoth­er per­son if they actu­al­ly rub against the shin­gle sores. So a per­son with shin­gles, if they feel well enough, can con­tin­ue nor­mal social or work life, they don’t have to stay at home. How­ev­er, if some­one who has nev­er had chick­en­pox rubs against the shin­gle sores then they would catch chick­en­pox from the shin­gles out­break. You have to think of chick­en­pox as the first thing and shin­gles is just the repeat out­break. Inter­est­ing­ly, chick­en­pox itself is eas­i­ly trans­mit­ted, you only have to be in a room with some­body with chick­en pox for 15 min­utes and you are expect­ed to have caught chick­en­pox. So chick­en­pox is in the air where­as shin­gles is not in the air, it is just trans­mit­ted by touch to some­body who has nev­er had chickenpox.

Evans: For those who have had chick­en­pox, which is prob­a­bly most of us – is there any way of not hav­ing shingles?

Nichol­son: Shin­gles gets trig­gered by all sorts of dif­fer­ent things, some­times noth­ing at all except get­ting old­er, but often it’s after an oper­a­tion or a fall. There is now a vac­cine to pre­vent shin­gles from devel­op­ing and it will be very cost effec­tive to vac­ci­nate peo­ple because although not every­one devel­ops post-her­pet­ic neu­ral­gia fol­low­ing shin­gles, basi­cal­ly, the old­er you are the more like­ly it is that that is going to hap­pen to you and if you’re unlucky and that shin­gles pain drags on, and it does for about 1 in 5, it can real­ly change your man­ner of liv­ing. You might need Social Ser­vice sup­port to do your shop­ping or one lady told me that she didn’t dare dri­ve any­more because the shin­gles pain for her was a stab­bing sen­sa­tion that hit her across her fore­head from time to time. She said ‘if I was dri­ving a car at that time, I would be unsafe on the road so I just don’t dare dri­ve any­more’. Anoth­er lady was telling me that her hus­band couldn’t bear wear­ing clothes because the shin­gles pain, in his case, was a super sen­si­tiv­i­ty of the area around his left ribs and just the brush­ing of his shirt across his ribs felt to be such an excru­ci­at­ing pain that he just didn’t want to wear a shirt.

Evans: I remem­ber my grand­moth­er, her face looked as if she had been burnt in a fire, she could not touch it.

Nichol­son: Inter­est­ing that you say that it looked like it because quite often the prob­lem is that it feels like that to the patient, a burn­ing sen­sa­tion is anoth­er one of the range of sen­sa­tions. You see because the nerve has been dam­aged, the pain can be felt in a myr­i­ad of dif­fer­ent ways. Any mes­sage that the nerve has at any time sent is what your shin­gles pain can be. So it could be a sen­sa­tion of burn­ing, itch­ing, intol­er­a­ble itch­ing that keeps peo­ple awake at night, stab­bing, aching, like a bruised sen­sa­tion, and if peo­ple have had it like your Nan on their face, they may have unnec­es­sary den­tal work done because they think the prob­lem lies in their teeth, that deep ache. So all those sorts of dif­fer­ent sen­sa­tions can be a result of the dam­age caused by the virus in the nerve. Which is why, quite frankly, I am hav­ing the vac­ci­na­tion myself (laughs).

Evans: That was Mar­i­on Nichol­son, Direc­tor of the Shin­gles Sup­port Soci­ety, and their web­site is shinglessupport.org. Don’t for­get that you can down­load all the pre­vi­ous edi­tions of Air­ing Pain or obtain CD copies direct from Pain Con­cern. If you would like to put a ques­tion to Pain Concern’s pan­el of experts or just make a com­ment about these pro­grammes then please do so via our blog, mes­sage board, email, Face­book, Twit­ter or pen and paper. All the con­tact details are on our web­site which is painconcern.org.uk. Now NHS infor­ma­tion on that shin­gles vac­cine says that it is licensed for use in peo­ple aged 50 and over. Although it can be used off label for peo­ple younger if a doc­tor feels it is suit­able and if a GP decides vac­ci­na­tion is appro­pri­ate it can be pre­scribed on the NHS. In oth­er cas­es the vac­cine will need to be giv­en at a pri­vate clin­ic. But from Sep­tem­ber 2013 peo­ple aged 70 will rou­tine­ly be offered the shin­gles vac­cine on the NHS with a catch-up pro­gramme for peo­ple aged 71–79.

Here is a final thought on shin­gles, I’ve had three chil­dren and I have got three grand­chil­dren now and I seem to remem­ber this chick­en­pox from my chil­dren isn’t going to be pleas­ant but let’s get it over with, let’s go to a chick­en­pox par­ty or some­thing. Now you seem to be say­ing that per­haps as a par­ent we should’ve avoid­ed that.

Nichol­son: On the con­trary chick­en­pox caught at a young age, usu­al­ly ear­ly child­hood, pri­ma­ry school age, is as you say a very mild dis­ease. In some coun­tries they do vac­ci­nate their chil­dren against chick­en­pox, but it’s done for com­mer­cial rea­sons rather than health rea­sons in that when the child has chick­en­pox the par­ents have to take a week off work. So in some coun­tries it is actu­al­ly done for that rea­son, and the inter­est­ing thing is, for the adult, the more times you have nursed some­one with chick­en­pox the less like­ly you are to have shin­gles because each time you meet the chick­en­pox virus you’re actu­al­ly devel­op­ing more anti-bod­ies, you’re giv­ing your­self a boost­er against hav­ing shingles.


Con­trib­u­tors:

  • David Wat­son, Gen­er­al Prac­ti­tion­er, Aberdeen and Chair of the SIGN Guide­line on Headache
  • Mar­i­an Nichol­son, Direc­tor of the Shin­gles Sup­port Society.

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