Erasing an Incredibly Painful Disease
May 26, 2006 — -- Sharon Smith doesn't mince words when she describes the intense pain of shingles, which she developed at age 61.
"I liken it to boiling oil being poured over your head," said Smith, of Portland, Ore.
Shingles is an extremely painful condition, because it infects the nerves and causes widespread blistering over the body. After the blisters heal, however, the nerve pain can remain for months, or years, a condition called postherpetic neuralgia.
It's triggered by a re-activation of the chicken pox virus, which can lay dormant for decades. While the disease is not fatal, living with the pain can be unbearable. Some patients even contemplate suicide, said Dr. Steven Black, director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif.
However, there's new hope that the disease may become a thing of the past. The Food and Drug Administration today approved Zostavax, a vaccine against shingles. Zostavax could potentially prevent this disease in half of the 250,000 people who develop it each year, a majority of whom are older than 60.
"It's not going to save lives. On the other hand, when you talk to individuals in that age group, shingles is something that they are worried about. It has a big impact on the quality of life because of the pain and misery associated with it," Black said.
Smith developed shingles on one side of her face, and doctors had to keep careful track of her eyes because the infection can result in severe visual impairment and blindness. During her illness, Smith could not drive and had to stop playing golf.
"When you are in that kind of pain it is hard to concentrate on anything other than getting through the day," said Smith.
Shingles primarily affects older adults because it is caused by the re-activation of the chicken pox virus most people have when they are young. As people age, their immune system can weaken, allowing the virus to flare up again.
At least 10 percent of people in their 60s and 70s suffer from shingles, and that number jumps to 50 percent among those older than 85, said Dr. Myron Levin, at the University of Colorado, and one of the directors of the clinical trial study that tested the vaccine .
"Everybody who has had chicken pox is at risk for shingles," said Levin.
Right now, painkillers and antidepressants treat the pain of shingles but they vary in effectiveness. That's because nerve pain does not respond well to many painkillers, and drug side effects, such as drowsiness, can result in other injuries, said Dr. Michael Oxman, at the University of California at San Diego, who also directed the clinical trial vaccine study.
The vaccine won't bring relief to everyone. Studies show that it works in only 51 percent of people and will not prevent shingles from recurring in those who have already had it.
Therefore, doctors and patients must weigh the risks and benefits. Only one out of five shingles patients has long-term nerve pain, so for many, the symptoms last a short time.
The cost and time to distribute the $145.35 shot could tax the overburdened health system; many doctors are already struggling to fit in routine primary care services, said Dr. Thomas Schwenk at the University of Michigan.
"Do I want to talk about a shingles vaccine or a mammography? " Schwenk said.
But for those at most risk for the disease, the vaccine is important.
"It's one more preventive medicine, which we need more and more of as people are aging." said Lyonel E. Zunz, who developed shingles when he was 85.