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Shingles and Postherpetic Neuralgia

Shingles is a disease caused by the same virus (Varicella zoster) that causes chicken pox. Acute, painful inflamed blisters form on one side of the trunk along a peripheral nerve.

Shingles usually affects the elderly or people with compromised immune function. Nerve pain that persists after other symptoms have cleared is called postherpetic neuralgia.

Rating Nutritional Supplements
df   Cayenne (topical; for pain only)
    Peppermint oil (topical; for postherpetic neuralgia)

Adenosine monophosphate (injection)
Vitamin B12 (injection)
Vitamin E

Licorice (topical)
Wood betony

Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.







What are the symptoms of shingles?

Symptoms include pain, itching, or a tingling sensation prior to the appearance of a severely painful skin rash of red, fluid-filled blisters that later crust over. The rash is typically located on the trunk or face and only affects one side of the body. Pain may resolve rapidly or persist in the area of the rash for months to years after the rash disappears.

Dietary changes that may be helpful for shingles and postherpetic neuralgia

Varicella zoster, the virus that causes shingles, is a type of herpes virus. Another herpes virus, herpes simplex virus (HSV), has a high requirement for the amino acid arginine. On the other hand, lysine inhibits HSV replication.1 Therefore, a diet that is low in arginine and high in lysine may help prevent herpes viruses from replicating. For that reason, some doctors advise people with shingles to avoid foods with high arginine-to-lysine ratios, such as nuts, peanuts, and chocolate. Nonfat yogurt and other nonfat dairy can be a healthful way to increase lysine intake. This dietary advice for shingles has not been subjected to scientific study.

Lifestyle changes that may be helpful for shingles and postherpetic neuralgia

Stress and depression have been linked to outbreaks of shingles in some2 3 but not all4 studies.5 A small, preliminary study found that four children with shingles outbreaks, but who were otherwise healthy, all reported experiencing severe, chronic child abuse when the shingles first appeared.6 Among adults, how a stressful event is perceived appears to be more important than the event itself. In one study, people with singles experienced the same kinds of life events in the year preceding the illness as did people without the condition; however, recent events perceived as stressful were significantly more common among people with shingles.
Nutritional supplements that may be helpful for shingles and postherpetic neuralgia

Adenosine monophosphate (AMP), a compound that occurs naturally in the body, has been found to be effective against shingles outbreaks. In one double-blind trial, people with an outbreak of shingles were given injections of either 100 mg of AMP or placebo three times a week for four weeks. Compared with the placebo, AMP promoted faster healing and reduced the duration of pain of the shingles.7 In addition, AMP appeared to prevent the development of postherpetic neuralgia.8 9

Some doctors have observed that injections of vitamin B12 appear to relieve the symptoms of postherpetic neuralgia.10 11 However, since these studies did not include a control group, the possibility of a placebo effect cannot be ruled out. Oral vitamin B12 supplements have not been tested, but they are not likely to be effective against postherpetic neuralgia.

Some doctors have found vitamin E to be effective for people with postherpetic neuralgia—even those who have had the problem for many years.12 13 The recommended amount of vitamin E by mouth is 1,200–1,600 IU per day. In addition, vitamin E oil (30 IU per gram) can be applied to the skin. Several months of continuous vitamin E use may be needed in order to see an improvement. Not all studies have found a beneficial effect of vitamin E;14 however, in the study that produced negative results, vitamin E may not have been used for a long enough period of time.

Because shingles is caused by a herpes virus, some doctors believe that lysine supplementation could help people with the condition, since lysine inhibits replication of herpes simplex, a related virus. However, lysine has not been shown to inhibit Varicella zoster, nor has it been shown to provide any benefit for people with shingles outbreaks. Therefore, its use in this condition remains speculative.

Are there any side effects or interactions with shingles and postherpetic neuralgia?

Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful for shingles and postherpetic neuralgia

The hot component of cayenne pepper, known as capsaicin, is used to relieve the pain of postherpetic neuralgia. In a double-blind trial, a cream containing 0.075% capsaicin, applied three to four times per day to the painful area, greatly reduced pain.15 In another study, a preparation containing a lower concentration of capsaicin (0.025%) was also effective.16 Two or more weeks of treatment may be required to get the full benefit of the cream.

One case report has been published concerning an elderly woman with postherpetic neuralgia who experienced dramatic pain relief from topical application of 2 to 3 drops of peppermint oil to the affected area 3 or 4 times per day.17 Each application produced almost complete pain relief, lasting approximately 6 hours. The woman began to experience redness at the site of application after four weeks of use. The oil was therefore diluted by 80% with almond oil; the diluted preparation did not cause redness, and continued to produce "adequate" though somewhat less-pronounced pain relief.

Licorice has been used by doctors as a topical agent for shingles and postherpetic neuralgia; however, no clinical trials support its use for this purpose. Glycyrrhizin, one of the active components of licorice, has been shown to block the replication of Varicella zoster.18 Licorice gel is usually applied three or more times per day. Licorice gel is not widely available but may be obtained through a doctor who practices herbal medicine.

Wood betony(Stachys betonica) is a traditional remedy for various types of nerve pain. It has not been studied specifically as a remedy for postherpetic neuralgia.

Are there any side effects or interactions with shingles and postherpetic neuralgia?

Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful for shingles and postherpetic neuralgia

Acupuncture may be helpful in some cases of shingles and postherpetic neuralgia. Anecdotal case reports of people treated with electroacupuncture (acupuncture with applied electrical current) described improvement in seven of eight people.19 A controlled trial, however, found no difference in response between acupuncture treatment and placebo.20 The authors of this trial reported some difficulty in evaluating the results due to difficulty in assessing measures of pain in this study group. Large, controlled trials using well-designed pain evaluation methods are still needed to determine the value of acupuncture in the treatment of shingles and postherpetic neuralgia.

Hypnosis has improved or cured some cases of postherpetic neuralgia, as well as the acute pain of shingles.21