Shingles, Day 43

So you thought I would be free of shingles by now? Well, so did I. I thought for sure that it would be somewhere in my rear view mirror, but alas, it isn't so.

These past several weeks have seen the shingles rash clear up with no scarring, but the pain has lingered around ever since.

First, there is a burning pain and stiffness, as if the skin on my neck was seriously sunburned, even though there is no redness or any other indication of lingering shingles rash. Then there is the pain beneath my jaw, which revolves between a deep ache, a searing pain, and an almost electrical shock. The pain has no real relationship to anything with regard to my head position at the time. Also, my ear feels swollen and burns, although it looks normal.

Worst of all is the itching. All I had read said there would be itching as the rash healed. I actually had virtually no itching from the rash, but since it healed, holy cow! The itching has been insane, especially at night. It seems like when I lay down, the itching will transition into warp speed, and I have frequently clawed at my head, neck, and ear for entire nights with no sleep. Nothing seems to control the itch.

Drug Therapies for Shingles

I have made many trips to the doctor in the intervening weeks between these posts. I couldn't handle the hydrocodone, so I saw a doctor and asked about something less likely to make me feel like a zombie. We discussed some options, and decided to try some lidocaine patches and meloxicam.

That lasted all of two days, after which my pain level had risen to a 9/10, and I found myself back to another doctor offering [begging] to take literally anything to shop the pain. She started me on Gabapentin and Tramadol. Gabapentin has to start at a low dose and gradually increase, so she worked me up to 600mg per day. However, that coupled with the Tramadol every 8 hours only got me down to a barely tolerable pain level of 5/10 at best, so I went to a pain specialist.

The pain specialist switched me to Gralise, a form of Gabapentin that you take once a day that is specially formulated for shingles, according to the accompanying literature. He put me on a schedule to increase my dosage from 600mg per day to 1800mg per day, along with the Tramadol. This keeps my pain level down to something in the 2-4 range. I am also able to lower the Tramadol to two a day rather than 3, which helps a lot in keeping me alert and able to get stuff done.

Getting a Stellate Ganglion Nerve Block for Post Herpetic Neuralgia [PHN]

Yesterday, the pain specialist performed a stellate ganglion nerve block for my post herpetic neuralgia. Say that five times real fast. Now, some of you may be thinking, it hasn't been three months yet, so how can it be post herpetic neuralgia? I guess I would respond that pretty much any pain that lingers after the rash heals could be considered PHN. 

 Bandaid showing the entry point for the stellate ganglion nerve block

Bandaid showing the entry point for the stellate ganglion nerve block

Anyway, I went to an outpatient surgical center where they put me under and performed this block in which they put a needle deep into my neck and injected a pain medication such as lidocaine along with an anti-inflammatory such as cortisone. The hope is that the nerves decide to take a holiday from all the overactivity and calm down over the course of the next week or so. 

I managed to have a reasonably itch free night, and pain and itch have been pretty well controlled with the Gralise and Tramadol halves over the course of today. I'm not sure how well this is going to work over time, but we'll see. 

Important to note is the fact that I might not ever be free of the drugs, and even if I have multiple nerve blocks, which is a very real possibility, I could still be many, many months in healing. 

The good news is that I am finding myself able to do a little more each day, which is reassuring, even if the timetable on recovery does not fit my personal schedule.