Shingles and Nerve Pain in Older Adults

What shingles looks like

Before the rash (one to five days): burning, shooting, itching, tingling or aching pain in a band on one side of the chest, back, abdomen, face or limb; skin may be very sensitive; some feel feverish, tired or have a headache. The pain may be mistaken for heart, lung, gallbladder, kidney or spine problems.

The rash: - Red or pink patches, then small blisters in clusters along one nerve pathway (a "dermatome"), usually on one side of the body only, often a band around the chest or waist, or on one side of the face, scalp or neck. - Blisters fill with clear fluid, become cloudy, then burst and crust over within about seven to ten days; healing takes two to four weeks, sometimes leaving scars or changes in skin colour. - Intense pain, burning or itching, which can be disabling. - Nearby lymph glands may swell.

On darker skin, redness may be harder to see; look for grouped blisters, swelling and a band pattern.

Why early treatment matters

Doctors can prescribe antiviral medicine that works best when started within about three days (72 hours) of the rash appearing. Started early, it can shorten the illness, reduce the severity of pain and lower the risk of complications; later treatment may still help in some situations, particularly for people at high risk or with eye involvement. If you suspect shingles, contact a doctor the same day. Do not wait for the blisters to burst, and do not rely on home remedies.

Emergencies and urgent signs

Call 112 or go to hospital or an eye emergency immediately for: - A rash or blisters on or near the eye, on the side or tip of the nose (a sign that the eye nerve is involved), forehead or scalp, with eye pain, redness, swelling, blurred vision or sensitivity to light. Shingles in the eye can damage vision permanently. - A rash near or in the ear, with facial weakness, ear pain, hearing loss or dizziness (Ramsay Hunt syndrome); see vertigo, BPPV and balance problems. - Severe headache, stiff neck, confusion, drowsiness, fever, fits (possible brain involvement). - Weakness or paralysis of a limb. - Widespread blisters beyond one band, or blisters that look infected: increasing redness, warmth, pus, red streaks, high fever (possible skin infection or spread). - Signs of stroke: facial droop, weakness on one side, speech difficulty; shingles slightly raises stroke risk in the weeks after; see stroke warning signs and the first hour. - A weakened immune system (cancer treatment, steroid-type medicines, immune-suppressing treatment, advanced illness) with shingles. - Chest pain, breathlessness with a rash on the chest: do not assume it is only shingles.

Caring for the rash at home

Always under medical guidance.

• Keep the rash clean and dry. Wash gently with mild soap and cool or lukewarm water, pat dry with a clean towel and wash the towel after; do not rub.
• Do not burst blisters or pick crusts.
• Cover loosely with a non-stick, sterile dressing or loose clothing when the blisters are weeping, to prevent spread and rubbing; change dressings as the doctor or nurse advises. Use soft, loose, breathable cotton clothing; avoid tight bands and synthetic fabrics.
• Cool compresses: a clean, cool damp cloth applied for short periods can soothe, but avoid ice directly on skin and do not leave wet cloths on the rash for long periods.
• Avoid creams, oils, powders, home remedies, such as turmeric paste, neem, coconut oil, calamine or herbal pastes, on open blisters unless the doctor advises; they can irritate or infect the skin. Do not use steroid creams or antibiotic creams unless prescribed.
• Avoid heat packs and heating pads on the rash; they can damage sensitive skin and worsen pain; see hot pack safety for older skin.
• Keep nails short and discourage scratching; for people with dementia, check hands.
• Wash hands after touching the rash.
• Temperature: check if the person feels unwell; see digital thermometers: choosing and using them for older people.
• Fluids and food: drink regularly, eat small nourishing meals; see hydration for older adults: how much and how to remember and loss of appetite in older adults: causes and practical fixes.

Managing the pain

Shingles pain can range from irritating to severe, and may disturb sleep, appetite and mood. Pain control is a medical matter; ask the doctor which pain medicines are suitable, since some pain relievers are unsuitable for older adults with kidney, heart, stomach or other conditions, and nerve pain often needs different kinds of medicine from ordinary pain. Do not use leftover or borrowed medicines, and do not increase doses; see painkillers and older adults and chronic pain in older adults: a whole-person approach.

Non-drug measures that may help:

• Loose, soft clothing and soft bedding; a cradle or pillows to keep sheets off the skin.
• Comfortable positioning with cushions and pillows to reduce pressure on the rash; see positioning a bedridden parent and wedge pillow in comfort and positioning.
• An overbed table for meals and activities without twisting; see hospital room at home: complete setup.
• Distraction and relaxation: music, radio, conversation, gentle breathing; see breathing exercises for seniors.
• Cool, calm surroundings, and a regular sleep routine; see insomnia in older adults: sleep hygiene and when to get help.
• TENS devices (electrical nerve stimulation) are sometimes used for nerve pain, but must not be placed on broken or blistered skin and should be used only after a clinician's advice; see TENS unit guide.
• A pain diary helps the doctor adjust treatment; see pain diary and talking to your doctor.

Postherpetic neuralgia (long-lasting nerve pain)

If pain persists more than about three months after the rash has healed, it is called postherpetic neuralgia. It is more likely in older adults, with severe early pain and severe rash, and may be burning, stabbing or electric, with extreme sensitivity to light touch (even clothing), numbness and sleep disturbance. It can lead to low mood, isolation and reduced activity. It is treatable to varying extents, and specialist pain clinics can help. Tell the doctor early if pain is not settling after the rash heals; do not accept it as inevitable. See chronic pain in older adults: a whole-person approach, and watch for low mood; see depression in older adults. If a person expresses hopelessness or thoughts of self-harm, seek help immediately; in India, Tele-MANAS (14416) is the national mental health helpline, but check the current number; call 112 if there is immediate danger.

Protecting others

• Shingles blisters contain live virus that can cause chickenpox (not shingles) in anyone who has never had chickenpox or the chickenpox vaccine, and who is not immune. Spread occurs by direct contact with fluid from the blisters, not usually through the air, unless the rash is widespread or the person has a weak immune system.
• Keep the rash covered, wash hands, and avoid sharing towels and bedding; wash bedding and clothes in hot water.
• Avoid contact with: pregnant women who have not had chickenpox, newborns, people with weak immune systems (cancer, transplant, steroid treatment), and anyone who has not had chickenpox, until blisters have crusted over.
• Carers who have had chickenpox are generally protected but should wash hands and wear gloves for dressings; see infection control for home caregivers.
• Once all blisters have crusted, the person is no longer infectious.

Prevention: shingles vaccine

Vaccines to reduce the risk of shingles and its complications are recommended in many countries for adults over fifty or sixty, including those who have had shingles before. The recombinant (non-live) vaccine is highly effective in older adults according to trials; live vaccines exist but are not suitable for people with weak immune systems. Availability and cost in India vary, and the doctor can advise on timing, eligibility, number of doses and side effects such as a sore arm, tiredness or fever for a day or two. Having had shingles does not fully protect against another episode, so ask about vaccination after recovery, usually after the rash has healed. See vaccines for older adults in India: a practical schedule.

Recovery and daily life

Most rashes heal in a few weeks. Fatigue may last longer; see slow recovery after infection in older adults. Support your parent with company, simple meals, comfortable clothing and patience. Watch for sleep problems, poor appetite, weight loss, low mood and falls (pain, medicines and weakness increase risk); see falls risk assessment at home.

When to ask a professional

See a doctor the same day if you suspect shingles, ideally within three days of the rash, and urgently for any rash near the eye or ear. Ask about antiviral treatment, pain management, wound care and vaccination. Ask a pharmacist about suitable products and interactions. Ask a pain clinic for persistent pain. Seek emergency help for the signs above; call 112.