• Dr. Jason Rountree

Laser for Shingles Pain

It's been a little while since I had the time to write another blog post, so I'm happy to be working on this one today! We're talking laser therapy of course, but specifically laser therapy for shingles pain. And this whole post is coming from a research study titled "Role of low-level laser therapy in post-herpetic neuralgia: a pilot study" and was published in Lasers in Medical Science in January of 2020 so this is a very, very recent study. It's pretty exciting stuff.


Post-herpetic Neuralgia

So specifically we're talking about shingles pain, which is technically called post-herpetic neuralgia (which translates to nerve pain after the shingles virus), and this post-herpetic neuralgia is the pain that persists after those shingles’ blisters have resolved. Now not every case of shingles will have residual pain afterwards, but a lot of them do. And in many cases, it can go on for a long time. In this study they say that "post-herpetic neuralgia is a painful condition which affects nerve fibers. It's the complication of herpes zoster [or the shingles virus] and it affects 50% of individuals over the age of 50 who have had shingles." That's a large number of people!


Shingles pain
Post-herpetic neuralgia

In many cases, pain can last for a very long time - months, or even years, I've seen some cases that are up to 20 years of ongoing pain and it's severe pain. In the article they say that "the pain complaints are often linked to feelings of tickling, burning, stabbing pain, a feeling of shooting or cutting pain, the feeling of crawling insects or trickling, sweat drops." And I've heard this described also as even like having a sensation of a hair brushing against the skin that you just can't get rid of. But in many cases, a lot of the post herpetic neuralgia or after shingles pain cases that I see are for that stabbing, burning, really severe levels of pain.


What is Shingles?

Before I get any further into exactly what the findings of this study were, I want to talk a little bit about the shingles virus itself. It's a virus that tends to hide inside the nerve. And then it can become activated either through trauma or stress, (there's a lot of different factors that can activate the virus) it irritates the nerve and inflames the nerve, and then you get pain and blister eruptions along the path of the nerve. This is very, very common along the rib cage. So, people will get pain that runs in a kind of horizontal line along the ribs. It kind of follows the ribs and does that pattern because that's the pathway the nerve takes from the spine out and around the outside of the body for cutaneous skin sensation. And because it's a nerve that carries sensation from the skin, when it gets inflamed, it sends you a lot more signals than it really should and the body interprets those as pain. And then the dysfunction of that nerve too, is where those eruptions come from. Once the body's got control of that virus and it settles back down the eruptions go away and in half of the cases or so the pain goes away too. In other cases that inflammation sets the nerve off and it becomes much more sensitive and will sustain that painful sensation, even though the virus is now dormant again, the nerve is still on high alert so it's still sending these pain signals.


So, this study was looking at the pain that occurs that is sustained after the actual shingles outbreak is contained. They say that it does "result from the inflammation of the sensory dorsal root ganglia of the affected skin," which is a part of the nerve back towards the spine.

They say that "chronic neuropathic pain needs medications on a regular basis, and those medications typically involve things like anticonvulsants, antidepressants, opioid medication, [Tegretol, Gabapentin, Lyrica, medications like those], can be prescribed. However, they do come with some significant side effects and some level of risk as well." That's why they did this study on laser treatment.


Shingles Pain Study

In this study, they enrolled patients who had been suffering from this post-herpetic neuralgia, for a month to a year and who had had no good response to the pharmacological treatments like Tegretol and Gabapentin. The pain just wasn't getting controlled by those drugs. And their outbreak of shingles had already been contained. The active outbreak was gone, but they had this post shingles pain going on. So, these researchers used laser therapy to try and reduce this nerve pain. Let's see how it worked.


So, they say in this study that "laser therapy has shown significant effects in reducing pain associated with neuralgia or nerve pain. When tissue is stimulated with laser therapy, it's regeneration is initiated, which includes new vessel formation, muscle and nerve regeneration, and production of cartilage collagen and even bone. It has a significant effect in reducing inflammation that causes the abnormal stimulation of nerves." In the case of post-herpetic neuralgia, they say "the safety and efficiency of laser therapy has been evidenced in treating a variety of skin diseases and in physiotherapy or physical therapy, it's used to treat a wide variety of chronic musculoskeletal aches and pains. In dentistry, it can be used to treat inflamed oral tissues and ulcerations and in dermatology to treat edema, ulcers, burns, dermatitis, and acne and for rheumatology to relieve pain and treat chronic inflammation and wound healing." There's a lot that you can do with laser. And so, with some evidence that it can be used for nerve pain reduction, they went ahead and started doing laser treatment on these patients. They did treatment sessions with laser twice a week for eight weeks, a total of 16 sessions. And they applied this non-invasive red laser to these painful points along the rib cage. One minute per point.


Laser Therapy for Chronic Shingles Pain

At the end, many of these patients went from severe pain to no pain at all. And remember this is with patients who have already had pain for a long time. Maybe even a year after the shingles outbreak was contained "resolved," they were still having pain. They had tried medications with very poor results. So, this pain relief isn't just something that was going to happen on its own, the laser actually stimulated this massive reduction in pain. The researchers say "Laser provides a non-invasive, painless, and safe method of therapy. Amazingly, patients get treated without any medication. In addition, this helped patients avoid the side effects of medicines. It can be concluded that laser therapy is an efficient modality for pain management in post herpetic neuralgia."


Laser treatment in Kalispell
Laser therapy is safe and painless

Now just because they saw these results does not mean that every single person with shingles pain will always get a hundred percent relief. They had a number of patients in their study that had significant relief, but not full resolution. They had patients that went from an eight out of 10 level of pain, down to a three out of 10 after these eight weeks of treatment. Still, that was a great improvement.


Laser for Shingles in Kalispell

Many times, I've been asked about studies like this one - does the pain relief last? What about later on? Was it just pain relief while they were getting the treatments, but the pain returns after they stop getting laser? Well, it turns out that this is long lasting pain relief for at least several months, as far as this study was able to track.


And so, if you're struggling with this, if you've already tried medications, laser treatment might be an option for you. I'd highly encourage you to set up a no-charge consultation with us here in Kalispell at Montana Laser. You'll be able to ask questions and find out if this could help you.