Living Well

Don't Suffer the Debilitating Pain of Shingles

It's known as one of the most painful illnesses anyone can experience...

Folks who have had it often say their skin felt like it was on fire. And unfortunately, a third of us will experience it at some point.

Each year, around 1 million Americans get shingles. And the danger the virus presents hit the news again recently thanks to a new study that found that contracting shingles increases your risk of stroke and coronary heart disease by 30%.

So today, we're going to share what shingles is, why it's so dangerous for your heart, and how to protect yourself...

What is shingles?

Shingles (or the herpes zoster virus) is an outbreak of painful redness and blisters. Herpes zoster develops from the chickenpox virus. So if you had chickenpox as a kid, that virus never left you. Some of the virus lies dormant in the nerves along your spinal column.

Later in life, that virus can wake up. When it does, it triggers excruciating blisters and redness on one side of the body. Typically it presents in a band along the torso, but it can occur anywhere. I saw a number of shingles patients in my ophthalmology practice, for example. That's because about 20% of shingles cases are in the eye (this is called herpes zoster ophthalmicus) and can lead to blindness.

Is it contagious?

You can pass the virus to someone else if they come into contact with your open blisters – and if that person has never had chickenpox. Basic preventive measures like handwashing and keeping your blisters covered help stop the virus from spreading.

What triggers a shingles outbreak?

If you've had chickenpox or gotten the chickenpox vaccine, the shingles virus is already inside of you. (There's some debate on the link between the chickenpox vaccine and shingles, but people who receive the chickenpox vaccine and later get shingles typically have less severe outbreaks.)

But there are some triggers that will make an outbreak more likely to activate:

1. Age. The older you are, the more likely your chance of getting shingles. One-third of Americans will get shingles at some point in their lives – and that number jumps to 50% for people over the age of 85.

2. A weakened immune system. This happens naturally as we age, but also in folks with certain diseases like irritable bowel syndrome and multiple sclerosis.

3. A stressful event. Stress is one of the biggest triggers for a shingles outbreak. Likewise, injury or even some surgeries may put enough stress on your system to trigger shingles.

4. Immunosuppressant drugs. Medications that suppress the immune system can also increase your risk of getting shingles. For instance, a study published in the journal Annals of the Rheumatic Diseases showed some evidence that rheumatoid arthritis ("RA") patients who were on immune-system-suppressing drugs like Humira and Enbrel had a higher chance of developing shingles than other RA patients.

Likewise, cancer patients going through chemotherapy or radiation also experience weakened immune systems and are at a higher risk of contracting shingles.

How does shingles damage the heart?

Shingles is an inflammatory disease. We've known for years that shingles does a lot of damage to your body. In 2015, a study in PLOS Medicine showed that the inflammation from a shingles outbreak affects the entire body. Researchers found that extra inflammation strains the cardiovascular system so much that a person with shingles will see their risk of stroke and heart attack double in the six months after the outbreak.

And a new study from Brigham and Women's Hospital found an even stronger link between shingles and the long-term risk of cardiovascular events. Researchers looked at the data for more than 200,000 patients from three different cohorts (studies done over long stretches of time). Researchers found a 38% greater risk of having a stroke for the first time among folk who had shingles compared with those who never had shingles. And the risk of coronary heart disease was 25% greater. Even after 12 years, there was still a significant risk of a cardiovascular event.

And this study is just the most recent we've seen over the years showing the damage shingles does to your heart.

What can I do to prevent shingles?

Your chances of getting shingles increase as you age. So keeping your immune system healthy by eating plenty of antioxidant-rich foods and staying active are great ways to remain healthy.

Also, use caution when you're around groups of kids. Whether or not exposure to kids with chickenpox helps or harms your own viral infection is still under debate.

Some studies of middle-aged folks show that reexposure to kids with chickenpox provides a "booster" to their immune systems. That helps keep shingles in hibernation for a few years. But since you lose antibodies as you age, this might not help so much if you're older – people aged 60 and older should still steer clear of chickenpox-carrying kids.

Also, if you're over 50 years old, you should get the shingles vaccine. It clearly cuts down both the pain and the actual occurrence of the disease. In a large, five-and-a-half-year study of 38,000 men and women across 22 sites in the U.S. Department of Veterans Affairs system, the vaccine was found safe compared with a placebo.

The usual complaints from a vaccine occurred: redness, swelling, pain, and irritation at the site of injection. Otherwise, this vaccine appears to be quite safe, and it reduces the pain and occurrence of the disease by at least 50%.

The good news is that the vaccine costs about $211, according to recent data from GoodRx. And while not every insurance company pays for it, Medicare Part D covers it the same way it covers regular vaccinations. And even if you have to pay cash... relative to the pain and suffering this disease causes... it could be the best health care money you ever spend.

How long does the pain last?

This is a question doctors hear all the time. Pain from shingles typically lasts about 30 days. However, in about 10% of shingles cases, the affected nerves still suffer even after the skin clears. That means the pain lasts for weeks... months... even years.

Few treatments help with the pain, and they come with their own risks. We've written before about the dangers of overdosing on acetaminophen. Other medications include certain types of opioids and antidepressants, but taking these long term leads to terrible side effects as well.

Some studies have shown promising results with a medicated patch applied to the area and left on for a short period of time. The patch contains capsaicin – the same thing in hot peppers that burns your mouth.

The downside is that the patch might cause its own pain from the capsaicin. Most patients in the study, however, said that the overall relief afterward was worth it.

If you develop shingles, see your doctor immediately. He may put you on antiviral medications to help reduce your risk of developing long-term pain from shingles.

People often refer to shingles as the most painful disease you will ever experience. I plan to do my best to avoid this horrible virus. Do what I do and get your shingles vaccine, manage your stress levels, and take care of your immune system by eating antioxidant-rich foods and staying active.

What We're Reading...

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
December 6, 2022