Shingles and Post-Herpetic Neuralgia
Shingles (“herpes zoster”) and post-herpetic neuralgia (“PHN”) are caused by a herpes virus. It is the same herpes virus that causes “chickenpox” (“varicella”) in children. Shingles represents a reactivation of the varicella-zoster virus (VZV).
The virus (VZV) resides in nerves and, if there is a compromise in immunity or for other reasons, the virus travels along peripheral nerves and causes an acute inflammation of the nerves (“neuritis”).
After the acute inflammation subsides, scar tissue (“fibrosis”) forms in the affected nerves and that may contribute to chronic post-herpetic nerve pain (PHN).
Microscopic studies show that there is considerable damage done to the peripheral nerves affected by the shingles virus, including not only fibrosis, but also loss of some of the myelin sheath that surrounds and protects peripheral nerves.
Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. [Ref. Malick-Searle, et al. “Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology.” J Multidiscip Health. 2016; 9: 447–454.]
In epidemiological studies, over 99% of adults aged ≥40 years had laboratory evidence of antibodies to VZV, indicating that they had prior exposure to VZV infection and were at risk of developing shingles. Id.
The symptoms of shingles are the presence of a painful, blistery rash on one side of the body that follows the path of a peripheral nerve. The pain can be mild or severe along the path of the nerve. When PHN develops, the pain can continue for months or years in the same place that the shingles occurred, long after the rash goes away. The pain is a burning sensation on the skin that even with light pressure or touch can be extremely painful. There may be numbness or tingling in the affected area.
In many patients, the pain from PHN gradually resolves, although it may take a year or more. However, there are some patients that having persistent, severe, and disabling pain for the rest of their lives.
Other symptoms can include mild fever and tiredness related to the viral infection.
Treatment of the shingles skin lesions and the viral infection is usually with antiviral medicines such as valacyclovir (Valtrex), famciclovir (Famvir) or acyclovir (Zovirax). The skin lesions typically resolve in about 3 weeks.
Treatment of PHN includes the use of “topical agents (lidocaine or capsaicin) and systemic agents, in particular, gabapentin (Neurontin), pregabalin (Lyrica), or tricyclic antidepressants (Elavil), but their efficacy tends to be suboptimal.” [Ref: Johnson RW, et al. “Postherpetic neuralgia.” N Engl J Med 2014; 371:1526-1533.] Topical lidocaine patches may help, and studies with tramadol have shown some efficacy in pain control.
Nutritional support may be of adjunctive benefit, with lipoic acid 300 mg 2x day, Acetyl-L-Carnitine 2,000 mg a day, Inositol (500-1,000 mg a day), and vitamins B6 (50-100 mg a day) and B12 (500-5,000 mcg a day. (See: “Energy Revitalization System” vitamin powder.)
Disability Benefits for PHN
For some, PHN is a chronic, painful and dsabling condition that can impair function and quality of life. PHN can be refractory to medication and difficult to treat. However, the pain from PHN is “subjective,” and because there are no tests or "objective" measures to prove-up the level of your pain, disability benefits may be hard to get.
Accordingly, it may be difficult to obtain long-term disability (LTD) benefits for PHN from Social Security (SSDI) or under an employer-sponsored group disability plan (ERISA). There is no “listing” for PNH in the Social Security “Blue Book.” The closest “listing” is for peripheral neuropathy at 11.14.
However, if your doctor can document your symptoms and functional limitations in your medical records with specificity, then it may be possible to obtain LTD benefits in some cases.
For example, if you have a painful extremity from PHN that limits your ability to lift/carry (< 10 pounds), stand/walk (<2 hours), or sit (< 6 hours), and the medical documentation in your chart is consistent, detailed, and specific, you may qualify for LTD benefits.
It is also possible to present evidence of chronic pain causing inability to concentrate, mental fogginess and fatigue (either from pain or medications), difficulty staying on task, having to lie down, or missing days of work, that, if well-documented, may also entitle you to a disability award.
Your disablity lawyer must work closely with your treating physician to get the proper documentation of your specific findings and impairments into the medical records. At Law Med that's what we do.