Forum: How I reduce the chances of my patients getting long-term nerve pain from shingles
Sign up now: Get ST's newsletters delivered to your inbox
As a doctor practising in a heartland neighbourhood, I would like to weigh in on the discussion on shingles vaccination (No subsidy for shingles vaccine as it is not cost-effective: MOH, Dec 9).
The cost of shingles vaccination, from $720 to $950, is beyond the reach of many of my patients. I thus adopt a different approach to reduce the chances of patients developing postherpetic neuralgia, or long-term nerve pain, which is what we are all afraid of (‘I wanted to bang my head’: How a delayed shingles diagnosis caused much suffering, Dec 9).
I warn all my patients who present with unexplained nerve pain without a rash of the possibility of shingles, and instruct them to look out for rash in the following few days. I often prescribe them a day’s worth of antiviral medicine in case the rash appears on a day when my clinic is not open, and also give them my phone number for communication.
Once I’ve established it is shingles – by asking the patient to come back for a review of the skin lesions, or them showing me the rash through teleconsultation if my clinic is not open – I ask the patient to start the oral medication and come back to the clinic the next day to collect the whole course of antiviral medicine.
In 2024 alone, I have had four or five patients with shingles benefit from this approach.
They started medication from day one of the clinical diagnosis, and by the time they completed the one week of medication, none of them had developed full-blown skin lesions and all of them recovered without pain.
Besides vaccination, which does not guarantee lifelong immunity, the key to not developing long-term nerve pain is early diagnosis and the start of appropriate treatment.
Perhaps public education and creating awareness of early symptoms of shingles are more cost-effective in preventing postherpetic neuralgia.
Gervis Chua Teo Ngee (Dr)