November 9th, 2009
If you have ever had shingles, or know someone who has gotten it, you will understand just how painful and uncomfortable it can be. Most massage therapists will not see an active case in their office, as the discomfort is so great that a person can experience excruciating pain merely from the weight of light clothing or even just a breeze blowing across his or her body. Discover how massage can help as a preventative therapy, reducing the severity and extent of symptoms, as well as learn about some home remedies that can be of great benefit.
by Linda Fehrs, LMT
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Shingles is a viral infection causing a painful rash. Known also as herpes zoster, it is caused by the varicella-zoster virus, which is also responsible for chickenpox. While chickenpox is, for the most part, considered a children’s disease, shingles reserves itself for those quite a bit older, usually (but not limited to) people over 50.
Anyone who has had chickenpox is susceptible to getting shingles. Overall, only about 20 percent of those who contract chickenpox as children will eventually get shingles. The majority of those who develop shingles are adults over 50, the incidence increasing as one gets older, but there have been some children and even newborn infants who have been diagnosed with shingles. It is thought to follow a lessening of effectiveness in the immune system.
After having chickenpox, the virus causing it may not be completely eliminated by the immune system, remaining dormant in nerve cell bodies. Usually this causes no problems. Many years later, when the body’s immune system become less effective, or in persons with compromised immune systems (such as those with HIV/AIDS, organ transplant patients or those receiving cancer treatment), the virus can reactivate in the form of shingles. It will erupt along the affected nerve and produce blistery lesions on the body. No one know exactly why this happens, but it seems to be triggered when the immune system becomes weakened as a result of stress, fatigue, certain medications, medical treatments or other illness.
The first symptoms of shingles are not always obvious. There may be a general malaise combined with pain, burning, tingling, numbness (paresthesia) or extreme sensitivity (hyperesthesia) along certain parts of the body. The sufferer can also have swollen lymph nodes, an upset stomach and chills. A case of shingles can, at first, be misdiagnosed as pain from an ulcer, heart attack, migraine headaches, appendicitis or even a lower back problem, which is why someone in the very early stages might come to a massage therapist for relief in the first place. In rare cases a person may have pain, but no rash. This form of shingles is more difficult to diagnose.
The first symptoms may last anywhere from a few days to a few weeks before being followed by the definitive rash, evolving into tiny clear blisters on a red base, along with a slight fever and fatigue. The rash will usually appear on the trunk of the body, the neck or back depending on the nerves affected. The pattern of the rash follows dermatome lines, areas of the body innervated by individual spinal nerves. Most commonly affected nerves are those emanating from T3, T4 as well as the ophthalmic branch of the trigeminal nerve. The stripe or belt-like rash makes it fairly distinct visually from contact dermatitis, which may have irregular patterns or cover wider areas of skin.
Note: If shingles appears on the face, especially near the eyes, it needs prompt medical attention, even if the outbreak seems mild. If left untreated it can scar the cornea and lead to blindness.
Post Shingles Pain
About twenty percent of those who get shingles also experience post-shingle pain, or post-herpetic neuralgia (PHN). PHN is diagnosed when the pain lasts a month or longer after the blisters have healed. In some people, PHN may last for six months. For others it may last up to a year.
There is no clear-cut cause of PHN, but it may be brought about by an autoimmune disorder, or perhaps pain-inhibiting connections that are destroyed by infection. Without a definitive cause, effective treatment for the pain is hard to come by.
Prevention and Treatment
Not everyone who has had chickenpox will get shingles. One of the best ways to lessen your chances is to keep your immune system strong.
There are two vaccines on the market that may help prevent shingles – the chickenpox (varicella) vaccine and the shingles (varicella zoster) vaccine. The chickenpox vaccine was developed in Japan in 1974, but only became available in the United States in 1995, and is now a routine childhood immunization. The shingles vaccine is recommended for adults aged 60 and older, and is given as a single injection. Neither vaccine guarantees that you won’t get shingles, but it should lessen the severity of an outbreak and reduce the length of time you have it. It also reduces the risk of postherpetic neuralgia.
Benefits of Acupressure
During an outbreak of shingles, the pain is usually so intense that the last thing a person will want is for a massage therapist or anyone else to touch them. An alternative to traditional Western style massage is acupressure. Acupressure, which uses the theory of Traditional Chinese Medicine (TCM), considers shingles to be caused by a combination of both excess and deficiency in the body. It is also explained by the presence of pathogenic damp, heat and wind. Among other things, a practitioner of TCM would look at where the lesions are and how they manifest on the body in determining which points to treat. Working on the Triple Heater (TH) and Spleen (SP) meridians can help to boost the immune system. Dampness in the body can be treated using SP9 and SP6, while SP10 and LI11 (Large Intestine) can be used to cool the blood and treat skin problems.
The massage therapist is cautioned to keep clear of any rash suspected to be shingles. While shingles itself it is not considered contagious, a person who comes in contact with the fluid from a blister can contract chickenpox if they have not had it before or not been vaccinated against it.
Home Remedies Ease Symptoms
Treatment for shingles is mainly palliative. The doctor may prescribe such things as corticosteroids, narcotic pain relievers or other prescription drugs to ease the pain and itching, but with mild to moderate outbreaks there are also a few simple things you can do at home to ease the symptoms.
- Take an anti-inflammatory drug, such as aspirin or ibuprophen.
- Taking an antihistamine such as diphenhydramine (Benadryl for example) or using a non-prescription ointment containing at least one percent hydrocortisone can reduce the itching.
- Use cool water compresses to help soothe the pain and reduce the chance of skin infection. Adding 1 ounce of vinegar to 32 ounces of water will help its effectiveness.
- Topical lotions containing calamine may offer comfort and can be used on the rash and blisters.
- Take a cool bath. Add a small amount of baking soda, uncooked oatmeal or colloidal oatmeal (Aveeno) to the water to relieve itching and pain.
In most people, shingles will last anywhere from three to five weeks. The good news is that most people will only have one outbreak of this painful condition. Only about 10 percent of those who get shingles will develop it a second time.
Perhaps the best way a massage therapist can help with shingles is in the area of prevention. Stress has been shown to be one of the major factors in getting shingles. Massage can help reduce overall stress as well as help keep the immune system in good working order. Getting a regular massage may also help to reduce the symptoms by making the body better able to fight off the virus if it does flare up.
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Marley, Joyce. “Acupuncture Treatment of Shingles.” 24 April 2007. Acupuncture Services of Central New York. 3 Sep 2009 http://www.acupuncture-services.com/health-az/shingles/acupuncture-treatment-for-shingles.
Mayo Clinic Staff, “Shingles.” MayoClinic.com. 21 May 2008. Mayo Clinic, Mayo Foundation for Medical Education and Research. 3 Sep 2009 http://www.mayoclinic.com/health/shingles/DS00098.
“Shingles – Symptoms, Treatment and Prevention.” Health Encyclopedia – Diseases and Conditions. 1 April 2009. The HealthCentralNetwork, Inc. 3 Sep 2009 http://www.healthscout.com/ency/68/138/main.html.
Werner, Ruth. A Massage Therapist’s Guide to Pathology. 4th ed.. Baltimore : Lippincott Williams & Wilkins, 2009. Print.
Werner, Ruth. “Comforting Clients with Postherpetic Neuralgia.” massagetherapy.com. July 2006. Associated Bodywork and Massage Professionals. 3 Sep 2009 http://www.massagetherapy.com/articles/index.php/article_id/1194/Comforting-Clients-with-Postherpetic-Neuralgia.
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