Background

Postherpetic Neuralgia follows a rash called “herpes zoster.” Often called “shingles,” it is caused by the same virus that causes chickenpox. The first time you get chickenpox, the virus remains in your nerve endings even after the chickenpox is gone. This usually causes no problems. If the virus re-activates in one of the nerve endings, however, it causes a rash (small blisters) all along the distribution of that nerve. The rash of herpes zoster is characterized by being painful and being in a line totally on one side of the body. If it extends past the midline of your body, the rash is probably coming from something else. If the pain persists after the rash is gone, continuing for weeks to years (over one year in half of elderly patients), it is called "Postherpetic Neuralgia (PHN)." The pain tends to be burning, electric, or deep and aching. PHN affects between 500,000 and 1 million Americans — most of which are elderly. It can severely disrupt one’s life, but fortunately can now be effectively treated in most cases.

Treatment

If I see a new painful rash (not itchy) that fits the description of shingles, in addition to natural therapies I recommend immediate treatment with prescription antivirals for ten days. These are fairly benign (although expensive) and can prevent years of grief. They need to be started early on in the rash to be effective. The pain often precedes the rash, so with new shooting pains, I begin treatment when the first blisters pop up. The effects of treating this early are remarkable.

Medications

Beginning treatment early on in a shingles attack (within 48-72 hours) is critical. Though our focus is on natural therapies, this is a very good time to also add in the antiviral medication Valtrex (Valcyclovir). The recommended dose is 1,000 mg three times a day for a week for shingles, though I usually give 1,000 mg four times a day for 10 days, which often totally nips the attack in the bud. Although long-term use in AIDS patients can be toxic, it is generally very safe for short-term use otherwise.

Recommended Supplements

Acute shingles can be helped with the following supplements:

Vitamin B12

Take vitamin B12 injections daily for 10 days and then as needed. Alternatively, B12 sublingual tablets (5,000 mcg a day dissolved under the tongue) can be helpful.

Lysine

Lysine 2,000-2,500 mg/day may help starve the virus, though this has not been tested for shingles.

B complex

Take a good B complex vitamin to help support nerve healing.

Medication reminder

In addition to these supplements, it is most important that you take the prescription antiviral noted above.

Other Therapies & Advice

For post herpetic neuralgia

For post herpetic neuralgia (persistent nerve pain after shingles), see the general treatments and links under Neuropathy.  These can be very helpful.

Contributor: 

Dr. Jacob Teitelbaum, MD

Jacob Teitelbaum, M.D. is a board certified internist and author of the popular free iPhone application “Cures A-Z,” which was ranked in the top 10 of all health/wellness downloads on iTunes. Dr. Teitelbaum is the author of the perennial bestseller From Fatigued to Fantastic! (Avery Penguin), which has sold over half a million copies; Pain Free 1-2-3 (McGraw-Hill); Three Steps to Happiness: Healing Through Joy (Deva Press); the Beat Sugar Addiction Now! series (Fair Winds Press);  Real Cause, Real Cure (Rodale Press); The Fatigue and Fibromyalgia Solution (Penguin/Avery); and his latest, The Complete Guide to Beating Sugar Addiction (Fair Winds Press, 2015).