‘I have never felt such pain’: When shingles hits hard and causes lasting discomfort
Businessman Lionel Lee shares his experience with shingles, a condition that causes debilitating pain and potential long-term complications.
For a good part of the year, businessman Lionel Lee has been suffering from recurring pain in his back. There’s no telling when the episodes would hit – waves of discomfort could set in when he’s sitting at his desk typing or lying in bed at night.
The 56-year-old’s ordeal started in January, when he developed a severe case of shingles. His experience was so intense and painful that he still bears the mental and physical scars today.
Mr Lee’s experience is not uncommon among people diagnosed with the disease. Said Dr Pan Jiun Yit, senior consultant dermatologist, National Skin Centre: “The condition can be very disabling due to severe pain.”
Estimated to affect one in three adults in their lifetime*, shingles is a serious condition. Dr Singh Prit Anand, director of pain management service, and senior consultant at the department of anaesthesia and surgical intensive care at Changi General Hospital, warned that “complications can last for a few months, or take years or even a lifetime to resolve themselves”.
WHAT CAUSES SHINGLES
Shingles occurs when the varicella zoster virus – the same virus that causes chickenpox – is reactivated after remaining dormant in individuals who have been exposed to the virus previously.
Dr Edwin Chng, medical director of Parkway Shenton, shared: “Anyone who has had natural infection with the chickenpox virus or had chickenpox vaccination can develop shingles, and this risk for developing shingles increases with a decline in a person’s immune system.”
People who are immunocompromised or those aged 50 and above face an increased risk of shingles, added Dr Pan.
Dr Singh agrees. “Age-related decline in immunity is the dominant driver of shingles,” he said.
Reactivation of the virus can also be triggered by other concurrent illnesses, and even physical or emotional stressors.
Shingles affects youths and younger adults as well, Dr Chng pointed out. Possible risk factors are similar for those in older adults: For example, when one is in an immunocompromised state due to an acute or chronic illness or when one is under extreme stress.
Additionally, reduced immunity after a COVID-19 infection has been associated with an elevated risk of shingles, Dr Chng said. “A recent study in the United States showed that those diagnosed with COVID-19 had a 15 per cent higher risk of shingles compared to those who did not have COVID-19. This risk increased to 21 per cent if they had been hospitalised with COVID-19,” he said.
PERSISTENT PAIN, LINGERING DISCOMFORT
Mr Lee, who contracted chickenpox when he was 13, did not suspect that he had shingles when symptoms appeared. It started as back pain, which worsened over the day and progressed to his chest on the left side.
Recalling the intense pain, Mr Lee said: “As I was showering, the pain on my chest got more profound. I have never felt such pain or discomfort before. Thinking it might be the onset of a heart attack, I decided to get myself checked at the nearest A&E.”
Blood tests and an electrocardiogram found no sign of a heart attack, and Mr Lee was discharged after observation, though the pain persisted.
Over the next few days, the shooting pain became so severe that painkillers had little or no effect. Mr Lee was diagnosed with shingles when he noticed blisters on his skin; it was five days after the early symptoms started.
Till now, Mr Lee experiences lingering discomfort even after the blisters on his back have dried up. With the traumatic memory etched in his mind, he shared that he still wakes up recalling the pain and hardship he went through earlier this year.
DEALING WITH COMPLICATIONS
Dr Singh said that common complications post-shingles include chronic neuropathic pain, vision loss, skin scarring and hearing loss. “The disease has also been linked to an increased risk of stroke and cardiovascular complications (such as heart attacks), with the highest risk presented in the first week or month after diagnosis.”
With neuropathic pain, the body sends pain signals to the brain unprompted. People who experience this type of pain usually describe it as a burning sensation. Affected areas may be sensitive to touch.
Shingles can also cause Ramsay Hunt Syndrome, a condition that singer Justin Bieber experienced recently, Dr Chng noted. It is a rare complication that affects the nerves on the face, usually on one side.
Postherpetic neuralgia is another complication, he added. Affecting almost one in five patients aged 70 and older, it causes a burning pain that persists long after the shingles rash and blisters disappear. “It can be very debilitating and difficult to manage. In very severe cases, the patient may experience profound psychosocial difficulty, such as insomnia, loss of appetite and diminished libido,” said Dr Chng.
According to Mr Lee, many of his friends have experienced side effects from shingles. “After I was diagnosed, I received a lot of text messages and calls from concerned friends. Many shared about their ongoing struggle with damaged nerves. Some of my friends have had complications related to vision,” he said.
The cost of treating shingles can add up. This includes the cost of medications and consultations with doctors, Dr Pan shared. “There may be a need for the patient to take time off work. Family members may also need to do so in order to care for the patient as the severe pain can be very disabling,” he added.
Dr Singh noted that published literature shows that direct and indirect costs of shingles and its complications were between S$360 and S$470 per treatment in the last decade. This could rise to S$3,000 and more if hospitalisation is required.
PROTECTING AGAINST SHINGLES
Currently, treatment options for shingles include antiviral therapy. However, there are some challenges in treating shingles, Dr Chng said.
“Antiviral therapy should be initiated within 72 hours after the onset of infection for optimal results. In addition, the antiviral drugs have to be taken three to five times a day for at least seven days. The frequent dosing may result in compliance issues,” he said.
Dr Chng added that while benefits of antiviral therapy are more apparent in patients older than 50, the efficacy of treatment in younger patients is not well established.
According to the doctor, vaccination can help to reduce the risk of developing shingles and postherpetic neuralgia, as well as prevent reoccurrences of shingles.
Dr Singh noted that the duration of protection and the effect of preventing postherpetic neuralgia may vary between the available vaccine options. “Patients who are interested in shingles prevention are advised to discuss their options with their healthcare provider,” he said.
Learn more about shingles and prevention options for adults aged 50 and above.
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*Harpaz R, Ortega-Sanchez IR, Seward JF; Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention. Prevention Of Herpes Zoster: Recommendations Of The Advisory Committee On Immunization Practices. MMWR Recomm Rep. 2008;57 (RR-5): 1-30.