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Shingles: Understanding the disease and its effects on the patient and family

Adults above 50 are at higher risk of getting the disease, which causes painful blisters that could lead to short- and long-term complications

The pain from shingles is often described as aching, burning or stabbing. PHOTO: GSK

Despite getting shingles more than a decade ago, Madam Wong Yet Chau, 88, still experiences occasional pain near the initial rash site.

The pain, whenever it resurfaces, is a harsh reminder of her ordeal when she first got the disease. It first started with a sudden sharp pain on her right ribs. Her daughter Ms Chia Meng Ru, who is in her 40s and her main caregiver, was worried and unsure of what to do.

A couple of days later, her mother, Madam Wong Yet Chau developed a large blister. It took multiple trips to the GP – along with added stress and anxiety for both patient and caregiver – before Mdm Wong was finally diagnosed with shingles.

“I did not know much about the illness except that it is similar to chickenpox, and someone with lower immunity, such as the elderly, are more susceptible to it,” says Ms Chia.

What followed the diagnosis were multiple trips to the doctors, both general practitioners and specialists, for check-ups and to get medications for the pain. However, the medications could not ease the pain and discomfort completely.

“I had to constantly reassure my mum that the pain is only temporary and that it would go away. But it didn’t go away for a long time. She would ask: ‘Why is the pain still there? How come it keeps coming back? Isn’t there a way to cure it?’ There was not much we could do except to make sure that she continued to take her medication, and to keep her as comfortable as possible,” says Ms Chia.

Mdm Wong says she often felt “lost and helpless” during the treatment process.

Seeing her mother suffer from pain took an emotional toll on Ms Chia. She was also worried about the health of her mother, who was 78 years old then. Having to adjust her work schedule and take days off from work to accompany her mother to the doctor also added to her stress.

“We were quite helpless at that time. We had to seek out all these doctors, find out where they were based and make appointments. I also had to shift my schedule to fit the doctor's availability,” she adds.

Although not as intense now, Mdm Wong’s pain still comes and goes. It is a common complication of shingles known as postherpetic neuralgia, which affects the nerves and skin, causing pain long after the shingles rash is gone.

Mdm Wong Yet Chau (left) often felt “lost and helpless” when she was undergoing treatment for shingles. Her daughter, Ms Chia Meng Ru (right), was her main caregiver. PHOTO: GSK

How shingles progresses 

“Even after the body recovers from chickenpox, it doesn't quite expel the virus and it remains dormant in the nerve cells. When the body is stressed from various reasons – it could be medical, mental, physical, emotional stress – the virus is released from the cell body, travels along the nerve fibres to the skin and erupts as shingles,” says Dr Leong from Rophi Clinic at Mount Elizabeth Novena Hospital.

Dr Leong explains that postherpetic neuralgia occurs because the nerve has been damaged as the virus travels along the nerve fibres, leaving “a path of destruction”.

“If the nerve fails to recover, the pain will persist, possibly for a long time. Hence, prevention is better than cure,” says the infectious disease doctor and specialist.

The most effective prevention method against shingles is vaccination.

Studies have found that the virus can reactivate in one in three adults1. The risk of shingles occurring is higher in adults above 50 due to the age-related decline in immunity.

Shingles happens in the majority of healthy individuals as well, says Dr Philip Koh Kheng Keah, senior family physician and chairman, Medical and Ethics Board at Healthway Medical.

Apart from old age, other risk factors include being female, having chronic medical conditions such as diabetes and chronic heart and lung diseases, or a family history of the virus, he adds1.

Shingles commonly starts with a feeling of pain in a specific area, before a rash appears. After one to three days, the patient may notice a group of blisters in the same area2.

“For some, the pain can be excruciating and it’s often described as aching, burning or stabbing. Some patients may also experience fever, headache or fatigue,” says Dr Koh. He also cites a study that states that pain from shingles was rated worse than labour pain.

If not treated immediately, shingles may lead to other complications. The most common is postherpetic neuralgia, like what Mdm Wong experienced. There is also increased risk of stroke, heart attack, and skin complications such as bacterial superinfection2.

Unfortunately, not many people are aware of the disease.

Dr Jim Teo Yeow Kwan, consultant respiratory medicine, internal medicine and intensive care medicine from The Respiratory Practice, highlights a common misconception that shingles is a one-time infection like chickenpox.

Although rare, shingles can happen more than once, he says.

See a doctor as soon as possible to avoid complications

While pain medications may be used to relieve the symptoms, they are not wholly effective in preventing the symptoms from surfacing.

It is best to see a doctor as soon as possible when you experience symptoms such as a sudden painful rash as the risk of developing complications is highest in the first two weeks, says Dr Leong. The rash typically appears on one side and area of the body, usually on the torso, although it can also appear on the face and neck.

Furthermore, direct contact with the fluid from shingles rash blisters can transmit the chickenpox virus to unprotected people.

Dr Teo adds that patients should see a doctor within 72 hours of a rash occurring as it is the most effective period for treating the disease and preventing complications.

Complications may lead to added medical fees. If the patient has to be hospitalised, the medical bill may add up to the thousands.

After her mother’s experience with shingles, Ms Chia now has a better understanding of shingles and the importance of getting vaccinated against shingles.

“Vaccination to prevent shingles is important. Not only does it protect against shingles, it also reduces the complications of shingles. The cost of vaccination outweighs the costs of getting shingles,” says Dr Koh.

Although Mdm Wong did not take the vaccine, Ms Chia says: “I hope that everybody will be able to know more about the disease, and if possible, not have to go through the stress and pain like my mum did.”

To learn more about shingles, adults over 50 years old or their family members and caregivers should speak to their healthcare provider. Visit this website (#stopshinglesSG) for more information.

Footnotes:

1 Harpaz R et al. MMWR Recomm Rep 2008;57:1-30; quiz CE2-4. 
2 Kawai K, et al. BMJ Open. 2014;4:e004833.
3 National Population and Talent Division, Strategy Group, Prime Minister’s Office, Singapore Department of Statistics. Population in brief 2020. Accessed May 2022.
4 Chen L-K, et al. BMC Infect Dis. 2017; 17:213. doi: 10.1186/s12879-017-2198-y.
5 National Foundation for Infectious Disease. Shingles myths and facts. Accessed May 2022.
6 Society of Infectious Disease, Singapore; College of Family Physicians, Singapore. Handbook on adult vaccination in Singapore 2020.

This content is brought to you by GSK. This content is published on November 2022 and is valid till November 2024. NP-SG-HZX-ADVR-220004.

All images used in this material are for illustration purposes.
©2022 GSK group of companies or its licensor

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