Any advise for post shingles pain unrelieved by ultram, ...

There are many other meds out there to try for immunocompromised individuals and it appears that you really have not tried too many of them. I will admit that you have tried medications but perhaps not the right ones. You may need to go with antiviral medications to assist you on this.

I would suggest that you go the antiviral route and see if some of these meds mentioned will help you. Take a look at the treatment section. It is specific in the meds.

http://www.nlm.nih.gov/medlineplus/ency/article/000858.htm

If I may further assist you please let me know. I will be glad to continue and help.

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The information you has sent is mostly about shingles in the beginning and not much about post herpetic neuralgia. Among the meds you note you don't suggest any of those I have tried in what is pretty much genralized canned information, not very specific to my problem. I'm talking about things like neurontin or lyrica or lysine which are pretty common things suggested. Not that I want you to repeat what I have already tried, but there is not much that goes beyond what I have already tried. Most of it is general infor about shingles that I am well past. Baths don't work. Cold sowers help briefly, not not for long. What about the idea that sugar is a complication for post herpetic neuralgia healing? Some have suggested this to me. Telling me that 50% of those people over 60 many have it for years, especially those with affected trigamenalnerve damage (which is not my problem) doesn't get me anywhere I haven't already been and is no help in a seach for relief. Your answer is not very relief-specific, mstly pot-boiler. It is really of no help ina nay respect. Sorry.

The medications mentioned within the link were all meds that you had not worked with on the immunocompromised side. This is why I posted them and left the ones that you made clear had not helped you. I will forward your question to other experts and an MD for further postings to your question. Thanks for using Just Answer and someone else will reply shortly.

4ren6 asked me to have a look at your question. A bit more history would be helpful:

When did you have the shingles? Where were they located?

Of the various medications - which of the medicines offered ANY relief (even a small amount)?

Did you have any problems with the medicines, or did they just not work?

Do you have any other medical problems? Are you currently taking any medications for this or any other medical problem? How old are you?


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I am 78. Shingles started March 25, 2006, with blisters lasting for about two weeks, but they never crusted or erupted. they weren't messy and didn't actually hurt very much, compared to now. (Some have suggested that such can be a precursor to post herpetic neuralgia.)
They started left of my navel, ran around to the left back and up to my "wing bone." That is, in general, where the current PHN pain is, but sometimes more specific in location; other times more generalized, such as a feeling of a general bad sunburn or, other times, an overall prickling -- other times, specific locale stabbing, then an overall general aching.
The only med that helped at all is (as my original questions states) lidoderm patches. I use three a day for 12 hours on/12 off with modest relief for, usually, no more than two hours. Blue Cross hates paying for them. I have tried liquid lidocaine, swabbed on, but it actually aggravated the stinging pain -- surpising in light of the somewhat effective lidodrem patches.
Even aleovera gel is aggravating. Capzasin is murder, even when applied as one who has had some success with it -- in areas away from the affected area, sort of drawing the pain away from the source? But then, olive leaf extract also helped her -- but not me.
All internal meds I tried had undesirable side effects, especially daytime sleepiness to the point of almost going to sleep while active and standing; either neurontin or lyrica caused hair loss three months ago. It is slowly growing back.   They were all constipating and caused some vocal raspiness (which is quite irritating for a university professor). I stuck with them all for at least 30 days and stopped upon the pain doctors' (two) recommendations when there was no pain relief and they didn't like the side effects.
I take liipitor (10 mg) for cholesterol (which I keep at about 150) which I have taken for en years and 5 mmg of blood pressure med (the name escapes me at the moment) which I have taken for three years following an angioplasty wth stent. BP runs about 120 to 140/60 or 70 with a resting pulse of 50 to 65.
At 78 I am physically active. I do have numbness in my right leg which resulted from a herniated disk that began last Dec. 5 (verified by an MRI) and left it untreated, as advised by a pain doctor, since after the first month of bad sciatica pain I was improving my mobility. He was right, and it cleared up almost entirely with only some numbness in a couple of months until shortly before the shingles hit me on March 25, just when I thought I was out of the woods. Since then, the numbness in my right leg has returned and is worse than before, but not to the point of being disabling. I am still on long ladders whenever my situation requires it. I just forge through the shingles pain on a daily basis when it is more tolerable because of the distraction caused by activity, I believe. Still, walking is more painful that being still.
Pressure on the stabbing sites actually helps; sitting in a firm-backed chair relieves it, and I sleep pretty well (with one Excedrin PM), even on my back, which actually relieves the pain by firm pressure against the mattress. That suririses others whom I know who can't get comfortable in bed.
The pain is not exactly debilitating (in the sense of stopping me from doing what I need to do), but it does sap my energy and make me pretty irritable. For my wife's sake, I hope you can help me (for her sake).
Yes, I have read your qualifications. I appreciate your experience. Whether you are able to live up to your 100% positive feedback rating remains to be seen (or read). I'll be quite honest with you in response as to the effectiveness of your advice. My face-to-face doctors' (four) batting averages aren't so hot, anyway.
At any rate, I will appreciate your consideration and advice with thanks.

Thank you for providing such a detailed history. I will start by saying that your physician have tried just about everything which has been shown to be effective based on the latest systematic reivew of the treatments for post herpetic neuralgia. Honestly, I'm not sure I have much to offer in the way of suggestion.

Here is the latest published review of the medical literature on the topic
Analgesic Therapy in Postherpetic Neuralgia: A Quanitative Systematic Review

The conclusion: The evidence base supports the oral use of tricyclic antidepressants, certain opoids, and gabapentinoids in PHN. Topical therapy with lidocaine patches and capsaicin is similarly supported. Intrathecal administration of methylprednisolone appears to be associated with high efficacy, but its safety requires further evaluation.

You have been on a tricyclic (Elavil), opoids (darvocet), gabapentinoids (Neurontin, Lyrica), lidocaine patches and capsaicin.

The one thing that you have not tried is INTRATHECAL (not epidural) methylprednisolone. There was a single trial with a relatively low number of patients enrolled, but it did seem to show rather dramatic results.

Also, since the pressure on the area seems to help you, I wonder if physical therapy (specifically trigger point therapy) may be efffective http://www.coloradocenter4pt.com/neuromuscular.html
I have often had good results with ischemic compression for trigger points - while your symptoms are not identical, it may be a local approach worth trying.

I wish I could offer you something more definitive, but you may want to talk with your doctor(s)/pain management people about trying the intrathecal injections.


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Thank you for a straight forward reply. Let me ask a couple of more things and I will then accept charges for whatever you have come up with. It has been helpful even tho there seems to be no "magic bullet."   The physical therapy idea at trigger poiints sounds worth a try; likewise the intrathecal injections. I will follow up on these.

I neglected to note that I also tried codeine with tylenol which an older retired doctor suggested; but he told me to quit after I had taken six doses in two days without relief. I asked the pain management doctor about vicodin, but he said if the codeine didn't do any good vicodin wouldn't, either.

Cold showers, I failed to note previously, have helped. I take at least two a day; but it is not convenient and they don't seem to be as effective as they were earlier. Same for cold compresses (a sack of frozen peas, for convenience).

You didn't express a reaction to my concern about a nerve block, which I am still curious about. The pain doctor, as I indicated, was ambivalent and said it would take at least three sessions (therefore, three risks) and would probably have to be repeated every three months or so. Do you have an opinion?

You also do not seem to have an opinion about so-called "alternative medicines." Some people I have talked to swear by them, but what I have tried hasn 't helped.

Just for your information: there has been something being advertised in reputable magazines (like Newsweek) -- an ointment called something like CIS (?) with a money back guarantee, specifically referring to post herpetic neuralgia in the ad as well as arthritis, etc. I got it and tried, perhaps not long enough before giving up (only about one week).   Maybe it wasn't a fair trial, but I got my $99 back. So it is probably legitimate in general.   Just for your information if you run across it and haven't yet heard of it.

I am impressed with the online service you provide (which I only stumbled onto and was sceptical of after the initial boiler-plate reply to my first question). So I have no trouble "accepting" the charge that goes with it, which I certainly will do after hearing from you again (or even if I don't hear from you again), with thanks for your time.

As for the Vicodin - it MAY work a bit better than the Tylenol with codeine - but I would not expect that much difference. Both of these can cause significant problems with constipation and drowsiness. The other problem with chronic narcotic use, the body develops tolerance, and the dose needs to be escalated over times and they can be difficult to get off of because of their addiction potential.

Cold showers - that would go along with my suggestion for physical therapy - you seem to improve with physical stimuli (pressure, cold etc), so I would expect that you would respond to one or more of the approaches that physical therapy has to offer. (A word of advice - find a therapist who is willing to try different approaches if the first one doesn't work. Also - don't totally give up on PT if the first one you see doesn't fix it. Physical therapy involves lots of ART - definite science based- but LOTS of "art", some are much better than others)

Nerves blocks MAY be effective - but there really isn't clear evidence that this is an effective approach for PHN. Again, as a last resort, it is something to consider. I would not oppose it, but you seemed reluctant to try this based on a "it may help" type of recommendation by your physician.

The problem with the "alternative medicines" is that they are sold based exclusively on testimonial evidence. You can find someone who will swear in court that a sugar pill cured their arthritis pain. This "placebo effect" is difficult to contradict in people's mind.
Let's say 100 people buy a product. 10 of them get better (for whatever reason, maybe it it the product, maybe they just got better because time had passed) The 90 people who did not get better, move on and try something else. The 10 who got better - tell EVERYONE they know about the "miracle" pill/cream/treatment that "cured" them. Their testimonials will be widely posted on the website(s) selling this "cure", but there will be NO clinical trials comparing the treatment to a "placebo" Years later, if/when somebody actually compares the "cure" to a placebo, one finds that 10 out of 100 people on the placebo get better, while 10 on the "cure" get better.

The biggest problem with "alternative medicines" and herbal remedies - there is no scientific evidence they will actually work as advertised. Also, since no real scientific studies have been conducted, nobody knows what the side-effects will be. Often these products are sold with the "natural" (implying this is a mark of safety) moniker. I try to remind my patients that the following are all "natural"; rattlesnake venom, poison ivy, hemlock, and anthrax spores.

I may be "biased" toward the scientific method - "Show me the evidence". Many of the current prescription medications are purified derivitives of traditional products; Digoxin (Foxglove), Botox (Botulism toxin) - but in each case, there are scientific studies proving they are both safe and effective. I rarely recommend products based on testimonial evidence alone - I try to recommend treatment based on evidence.


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