Question
QUESTION: I was diagnosed with shingles last year and had it in my upper thigh back muscle and lower back calf, right below the left buttock. I had it for 6 months. For the first 3 months there was no "breakouts". I quote that because the only breakouts I had were small acne-like pustules that never broke.
I was also told by my neurologists that these were very contagious, this right after I have been having my wife nightly rub the infected area with muscle rubs (Asorbine JR. Capsaicin...etc) for about a month after they appeared.
She never got infected in the least and everything I read says the lesions, or breakouts weep and ooze and are bruise colored... was I misdiagnosed?
I was given Vicadin-like pills and an anti-depressant, and taking both relieved the pain 90. My neurologists said the anti-depressant was reacting with the pain pills in some patients and since everything he prescribed did not work in relieving the pain he suggested that combination.
The pain pills started with an "L", sorry I cannot be more precise but last year I had thought it gone and cured.... move to last month.
I am a Certified Apple Tech. and work on a bar type stool with wheels on them. It is adjustable but I have it to where my feet can be flat on the floor, I am 6' 3". Recently I reached down to pick up a tool off the floor and felt a twinge in my left thigh in the same exact location of my previous shingles area.  I of course shook this off as a small muscle pull.
Every since then when I sit in a normal chair my ankle hurts, like I twisted it. Then when I stand my calf and thigh then hurt on a scale of 1-10 a 5 or 6 most of the time. When I drive, again my ankle acts up and it is very uncomfortable diving with a clutch shift. When I get out of the car or walk around, again the pain moves to the calf and upper left thigh, the same exact spot as the previous shingles.
Acetaminophen 2000mg or Ibuprofen 1600mg, taken different 24 hour periods, does nothing to help the pain. Yesterday I had the worse attack of pain at work, which was caught on security camera. I was limping around the tech shop when I felt hot, then nausea the intense, shingles intense, pain. I fell to my good right knee and could not put any weight on the left leg while this was going on. I was like that for 20 minutes, basically crying out in pain with my leg extended and I could not flex it or even move without screaming. As I said after 20 minutes it went from a pain threshold of 11 to my normal 5 or 6 and I completed the rest of my day, to the chagrin of my boss after he saw the security tape.
Elevating the left leg helps some. Sitting in a normal chair (computer desk chair) only irritates my ankle, until I get up and then my back left thigh and lower calf hurt. During all of this there are no pustules or any breakouts in the pain areas. Can shingles reoccur without lesions or is this something I had last year and was misdiagnosed?

ANSWER: Hi Jerry and thanks for writing,

You have my sympathies, I've had Shingles six times and know how painful it can be. Personally I always found simple Ibuprophen eased my pain more than the powerful narcotics ever did. I also took Lysine for three months and have never had another outbreak so I believe I cured the virus in my system.

Postherpetic Neuralgia (or Post Herpetic Neuralgia) -- Sometimes abbreviated as PHN -- is a form of chronic Shingles Pain. The Right Shingles Treatment Can Help Shingles treatments can help alleviate the shingles pain of postherpetic neuralgia (post herpetic neuralgia).

Shingles treatments can reduce shingles pain if we start an anti herpes virus drug within the first two or three days of symptoms. Such shingles treatment medicines include Famvir, Valtrex and Acyclovir. With or without shingles treatment most cases of shingles heal within a few weeks or months. However, if we don抰 obtain prompt shingles treatments, some 5 to 15% of shingles victims will go on to suffer from long-lasting chronic pain. This post-shingles pain is called Postherpetic neuralgia (also spelled: post herpetic neuralgia). Neuralgia means nerve pain. Another term for post herpetic neuralgia (postherpetic neuralgia) is PHN. Postherpetic neuralgia (post herpetic neuralgia) pain can last for many months, years or decades.

Shingles treatments within the first few days substantially reduces the chances of developing late stage PHN. Indeed, even without anti-viral medicines, prompt shingles treatment with pain medicines or nerve stabilizing tricyclic antidepressant medicine, can also reduce the risk of postherpetic neuralgia (post herpetic neuralgia). However, for reasons we don抰 understand, one can still develop PHN, even when one obtains prompt, early shingles treatment.

PHN starts with inflammation and damage within the shingles-infected nerve. But this is not all. The effects of shingles pain and nerve damage can also 揻low?backward through the infected nerve into the spinal cord itself. In this way PHN can disrupt the pain-conducting pathways within the spine, and from the spine, on into the brain. We call this nerve-damage induced pain neuropathic pain. At this late stage of post herpetic neuralgia (postherpetic neuralgia) there is no longer an active viral infection. Anti-viral treatments for PHN usually don抰 help. (Although there may be rare exceptions where antivirals might help.)

For some post herpetic neuralgia (postherpetic neuralgia) victims the pain is relatively modest 朼n annoying background ache, irritation or burning. Others with pain suffer shooting-pain paroxysms down the affected nerve. A third group with PHN has an even more disturbing postherpetic neuralgia (post herpetic neuralgia) pain problem. This is called allodynia朼 diffusely increased sensitivity to pain of all kinds and also to other stimuli that normally would not be painful e.g.light pressure and even touch.

Obviously the best thing you can do is to go back to your doctor asap and discuss appropriate treatment options - you want to avoid PHN if you can and prompt treatment is the best way.

I hope this helps and I wish you all the best,

Margot


Excerpts from: www.drpodell.org

---------- FOLLOW-UP ----------

QUESTION: Margot, thanks for the quick response!!
Here is an update on my condition. Seems like I may have been hasty, since the pain was in the same area as the Shingles I assumed it was a reoccurrence of Shingles, with no lesions, but I now feel it is a pinched nerve since on my left foot the three outside toes have gone numb along with the pads of my left foot and with all the research I have done, pinched nerve most closely matches all my symptoms.
Oh and about going back to my doctor that is not feasible at this time since he was paid $1800.00 and I just started a new job and do not have health insurance yet, so I don't have another $1800.00 for a neurologists. Also last time my old insurance plan had me go to one of those "doc in box" places first and they said go to a neurologists.
Since I do have the numbness in the left foot and I feel it is a pinched nerve I would like to ask you about, well pinched nerves.
You are right about Ibuprofen. Ever since I found out it was not Shingles, and 90 of the web sites said not to take Acetaminophen, taking Ibuprofen seems to take the edge off. But the numbness of my foot and toes is very irritating and I still have that pain in my upper thigh and back of my calf. That is where I am assuming the pinched the nerve is, in the upper thigh. After I initially wrote to you, within about 3 hours is when I noticed the numbness start, which was Saturday late afternoon and my pads and toes have been numb since then. I have had a 3 day weekend and have tried not to 揵aby?the left leg, but the pain has only allowed me to be couch bound. As I write this to you I am using one of my sick days to call in, since I am on my feet for a majority of the day.
Concerning the pinched nerve, the only minor relief I get is if I lay on my left side propped up so I am not laying flat and I have my left leg naturally extended. Don抰 get me wrong there is still pain but it just seems like I can handle it and don't feel like I have to move or fidget. This position has worked to get me about 8-10 hours of sleep since Saturday. Eventually if I don't fall asleep then I have to move. I usually go from bed to couch and back until I fall asleep.
I was also curious as to why it hurts to have a bowel movement? I was wondering this because I don't remember if I had any issues with going to the bathroom when I had Shingles. It might be just sitting on the hard toilet seat and the pressure against my thigh, but it does hurt and after I stand and I don't have the ability to put hardly any weight on the left leg, so I end up hopping or shuffling back to the couch/ bed in a lot of pain.
I want to thank you for your input also any thoughts about these new symptoms would also be greatly appreciated.
Jerry

Answer
Hi again Jerry,

Obviouly I'm guesing here, but itsounds like you might have Sciatica.

Sciatica pain
The term sciatica describes the symptoms of pain and possibly tingling, numbness or weakness that travels from the low back through the buttock and down the large sciatic nerve in the back of the leg. Sciatic pain is caused when a nerve root in the lower spine is pinched or irritated, and is commonly caused by a lumbar herniated disc, spinal stenosis, degenerative disc disease or spondylolisthesis.

The clinical diagnosis of sciatica is referred to as a "radiculopathy", meaning that a disc has protruded from its normal position in the vertebral column and is putting pressure on the radicular nerve (nerve root) in the lower back, which forms part of the sciatic nerve.

Sciatica occurs most frequently in people between 30 and 50 years of age. Often a particular event or injury does not cause sciatica, but rather it may develop as a result of general wear and tear on the structures of the lower spine. The vast majority of people who experience sciatica get better with time (usually a few weeks or months) and find pain relief with non-surgical treatments.


Description of sciatica
For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. Usually, sciatica only affects one side of the lower body, and the pain often radiates from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also radiate to the foot or toes.

One or more of the following sensations may occur as a result of sciatica:

Pain in the rear or leg that is worse when sitting

Burning or tingling down the leg

Weakness, numbness or difficulty moving the leg or foot

A constant pain on one side of the rear

A shooting pain that makes it difficult to stand up

Low back pain may be present along with the leg pain, but usually the low back pain is less severe than the leg pain

While sciatica can be very painful, it is rare that permanent nerve damage (tissue damage) will result. Most sciatica pain syndromes result from inflammation and will get better within two weeks to a few months. Also, because the spinal cord is not present in the lower (lumbar) spine, a herniated disc in this area of the anatomy does not present a danger of paralysis.

Symptoms that may constitute a medical emergency include progressive weakness in the leg or bladder/bowel incontinence. Patients with these symptoms may have cauda equina syndrome and should seek immediate medical attention.  In general, patients with complicating factors should contact their doctor if sciatica occurs, including people who: have been diagnosed with cancer; take steroid medication; abuse drugs; have unexplained, significant weight loss; or have HIV.

Sciatica nerve pain is caused by a combination of pressure and inflammation on the nerve root, and treatment is centered on relieving both of these factors. Typical sciatica treatments include:

Non-surgical sciatica treatments, which may include one or a combination of medical treatments and alternative (non-medical) treatments, and almost always includes some form of exercise and stretching. The goals of non-surgical treatments should include both relief of sciatica pain and prevention of future sciatica problems.

Sciatica surgery, such as microdiscectomy or lumbar laminectomy and discectomy, to remove the portion of the disc that is irritating the nerve root. This surgery is designed to help relieve both the pressure and inflammation and may be warranted if the sciatic nerve pain is severe and has not been relieved with appropriate manual or medical treatments.

While it may seem counterintuitive, exercise is usually better for healing sciatic pain than bed rest. Patients may rest for a day or two after their sciatica flares up, but after that time period, inactivity will usually make the pain worse. Without exercise and movement, the back muscles and spinal structures become deconditioned and less able to support the back. The deconditioning and weakening can lead to back injury and strain, which causes additional back pain. Exercise is also important for the health of the spinal discs. Movement helps exchange nutrients and fluids within the discs to keep them healthy.

Many sciatica exercises focus on strengthening the abdominal and back muscles in order to provide more support for the back. Stretching exercises for sciatica target muscles that cause pain when they are tight and inflexible. When patients engage in a regular program of gentle strengthening and stretching exercises, they can recover more quickly from a flare up of sciatica and can help to prevent future episodes of pain.

As a final note, regardless of the diagnosis, most types of sciatica will benefit from a regular routine of hamstring stretching. The hamstrings are muscles located in the back of the thigh. They help bend the knee and extend the hip. Tightness in the hamstrings will place increased stress on the low back and often aggravate or even cause some of the conditions that result in sciatica.

When doing the hamstring stretches, patients should avoid bouncing, which can trigger a muscle spasm.

from: http://www.spine-health.com/topics/cd/d_sciatica/sc01.html

I hope this helps and you're feeling better soon.

All my best,

Margot