Shingles results from reactivation of latent varicella-zoster virus in dorsal root or cranial nerve ganglia after previous chickenpox infection. Lifetime risk is approximately 20–30% in the general population, increasing significantly with age.
Incidence rises sharply after 50 years of age, and most cases occur in older adults or immunocompromised individuals. Post-herpetic neuralgia (persistent nerve pain after rash resolution) develops in about 10–20% of cases, with higher risk in older patients.
It can cause debilitating pain for a prolonged period even after disappearance of the rash. Management is aimed at reducing viral replication, controlling pain, and preventing complications.
Management relies on a multimodal strategy, including antiviral therapy (early treatment within 72 hours), pain management with analgesics, anti-neuropathic agents, topical treatments, and nerve blocks in refractory cases.
I offer following interventions tailored to individual need and requirement that can be complimentary to other treatment modalities, aiming towards reducing pain and improvement in quality of life-
- Trigger zone injections
- Nerve blocks (intercostal or paravertebral blocks)
- Epidural injections in selected cases
- Neuromodulation (spinal cord or dorsal root ganglion stimulation) for refractory pain where all other treatment modalities have proven unsuccessful/limited.
You can request your GP to arrange a named consultant referral to the Barts neuromodulation service to access these advanced treatment options if they are not available in your area.