Shingles is a viral infection that causes a painful rash.
Medically speaking, it is an acute viral inflammation of the sensory ganglia of the spinal and cranial nerves that is associated with vesicular eruptions and neuralgic pain caused by reactivation of the herpes virus causing varicella (chicken pox)—also called herpes zoster, zoster.1
Studies show that more than 99 percent of Americans aged 40 and older have had chickenpox, even if they don’t remember getting the disease. Most people who get shingles will have it only once. Each year, about 96 shingles-related deaths occur in the United States.2,3
Approximately one out of three people in America will develop shingles during his or her lifetime. That is nearly one million people each year. As people age, their vulnerability of contracting this disease increases, with about half of all shingles cases occurring in people aged 60 or older.4
Given the ubiquity of this malady, alternative methods have been developed to alleviate the painful effects of shingles and some of these are of interest to the chiropractor.
Standard treatments
Pharmaceutical advertisements promote a shingles vaccination. Who should get the vaccine? The Centers for Disease Control and Prevention (CDC) recommends that people aged 60 and older get the shingles vaccine to prevent an outbreak, as postherpetic neuralgia (PHN) is a complication of shingles.5 PHN affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.6
Shingles vaccine has been used since 2006, and Zostavax is the only vaccine currently approved in U.S. This vaccine reduces the risk of developing shingles by slightly more than 50 percent and PHN by almost 70 percent. It is administered in one dose as a shot, and can be given in a doctor’s office or pharmacy.2
Standard biomedical treatments for herpes zoster include analgesics for pain, soothing lotions, wet compresses, and steroids. Taken at the first sign of an outbreak, acyclovir may lessen the severity of the attack.7
A noninvasive approach
Photobiomodulation, also known as low level laser therapy (LLLT), offers a noninvasive and effective treatment for shingles. There are multiple research papers demonstrating the effectiveness of LLLT for treating both acute and chronic shingles.8-12
Craig Hales, MD, a physician and epidemiologist at the CDC, states, “Herpes zoster rates among adults have been slowly rising over time in the U.S. and other countries. In the U.S., herpes zoster rates have increased by 39 percent from 1992 to 2010 among adults older than 65 years of age.”3
This author has been in private practice for 30 years, and has seen an increase in the number of shingles cases treated in the last five years.
LLLT has proven to be an effective treatment for shingles pain and can result in resolution of the outbreak.8-12
For example: With a patient who had suffered from PHN for 18 years, a few sessions of LLLT reduced her pain by 80 percent. This LLLT treatment with super-pulsed laser (SPL) was a non-contact laser application (the laser emitter did not contact the patient’s skin).13
A typical protocol, when treating HZ patients, is to hold the SPL emitter 0.5 to 1 cm above the affected area. The patient should feel nothing during the treatment. After three to four minutes into the session, patients may describe a cooling sensation in the painful area. The pain will continue to abate as the session continues.
Patients often attest to pain relief while still on the treatment table after the first treatment. The classic rash and vesicular eruptions associated with HZ should show marked reduction after follow-up treatment 24 hours later.
Prior to treatment, have the patient touch the painful area and make a mental note of the severity of the pain and then have them touch the same area post-treatment. The relief they experience assures them they are on the right treatment path.
Pain relief with LLLT is well-established in scientific literature. At the National Institutes of Health (nih.gov) or PubMed (ncbi.nlm.nih.gov/pubmed) websites, you can search for LLLT, photobiomodulation, phototherapy, and laser therapy papers. You will find extensive peer-reviewed research on the effects of LLLT and SPL on pain abatement. The science is overwhelmingly in favor of using this modality for pain of all types and there are no reported contraindications.
Christopher Carraway, DC, DIBCN, CLS, is a board- certified chiropractic neurologist with the International Academy of Chiropractic Neurology and a charter member of the National Institute of Chiropractic Research. He is a clinical advisor to Laser Therapy U, and was awarded a fellowship with the International Board of Clinical Neurology. He is the senior medical advisor for Multi Radiance Medical. He can be contacted through lasertherapyu.org.
References
1 “Shingles.” Merriam-Webster.com, 2015. http://www.merriam-webster.com/dictionary/ shingles. (May 2016).
2 Centers for Disease Control and Prevention. “Vaccines and Immunizations.” http://www.cdc.gov/vaccines/vpd-vac/shingles/ vacc-need-know.htm. Published Sept. 2011. Accessed Dec 2015.
3 Centers for Disease Control and Prevention. “Morbidity and Mortality Weekly Report.” http://www.cdc.gov/mmwr/preview/mmwrhtml/rr 5705a1.htm. Published May 2006. Accessed May 2016.
4 Insinga RP, Itzler RF, Pellissier JM, Saddier P, Nikas AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20(8):748-753.
5 “shingles.” Merriam-Webster.com, 2015. http://www.merriam-webster.com/dictionary/ shingles. (May 2016).
6 Mayo Clinic Staff. 2014. “Disease and Condition – Shingles.” Dec 11. http://www.mayoclinic.org/ diseases- conditions/shingles/basics/definition/ con- 20019574
7 Gaeddert A. How Do You Treat Shingles? Acupuncture Today. 2004;05(02).
8 lijima K, Shimoyama N, Shimoyama M, Mizuguchi T. Evaluation of Analgesic Effect of Low-Power He: Ne Laser on Postherpetic Neuralgia Using VAS and Modified McGill Pain Questionnaire. J Clin Laser Med Surg. 1991;9(2):121-126.
9 Moore KC, Hira N, Kumar PS, Jayakumar CS, Ohshiro T. A double blind crossover trial of low level laser therapy in the treatment of postherpetic neuralgia. Laser Therapy. 1989;1(1):7-9.
10 Ohtsuka H, Kemmotsu O, Dozaki S, Imai M. Low reactive-level laser therapy near the stellate ganglion for postherpetic facial neuralgia. Masui. 1992;41(11):1809-13.
11 Kemmotsu O, Sato K, Furumido H, et al. Efficacy of low reactive-level laser therapy for pain attenuation of postherpetic neuralgia. Laser Therapy. 1991;3(2):71-75.
12 Numazawa R, Kemmotsu O, Otsuka H, et al. The rôle of laser therapy in intensive pain management of postherpetic neuralgia. Laser Therapy. 1996;8(2):143-148.
13 Carraway C. “905 nm Super Pulsed Laser Therapy for the Treatment of Shingles (Herpes Zoster).” A presentation at the North American Association for Laser Therapy 2013 conference at Palm Beach Gardens Jan 31-Feb 2. https://www.youtube.com/watch?v=RtC5CT5X uAw. Published Feb 2013. Accessed May 2016.
