The painkiller oxycodone is effective at treating the acute pain of shingles.
The study carefully evaluates different methods to relieve pain during a course of shingles, which many patients say causes the worst pain they have ever experienced. Effective pain treatment is crucial. Not only can the pain of shingles disrupt people’s quality of life, but it is also possible that the less effectively the pain is treated, the more likely it will become a long-term problem that can change a person’s life forever.
For most patients, the first symptom of the infection is pain, quickly followed by a rash where the pain first appeared. The rash appears most often on one side of the chest or face, oftentimes causing dozens of small pimple-sized lesions. Some patients also get flu-like symptoms like a headache and lethargy. The illness usually lasts about three or four weeks.
Pain is the hallmark and typically the most troubling symptom. Nearly all patients hurt to some degree, some severely. It’s is a mix of pain that results from damage to nerves – known as neuropathic pain – as well as inflammatory pain in the skin and surrounding tissues.
‘Oftentimes patients are told that the rash will heal in two or three weeks anyway, and the pain will go away, so they’re not given something for the pain unless it’s excruciating,’ said Robert Dworkin, Ph.D., the University of Rochester Medical Center pain expert who led the study. ‘But moderate pain can stop people from working, or enjoying their hobbies, and it can also make some people depressed or anxious. So there’s good reason to treat all pain from the infection.’
Doctors have a variety of choices to treat shingles pain. Medications like ibuprofen or acetaminophen are often used. More severe cases might call for use of Tylenol with codeine or oxycodone. But there haven’t been placebo-controlled studies done to prove that any of these drugs actually work to treat shingles pain, said Dworkin, who is professor of Anesthesiology, Neurology, Oncology, and Psychiatry, and director of the Anesthesiology Clinical Research Center.
So Dworkin and colleagues studied 87 shingles patients in Rochester, N.Y., and Houston, Texas. The team studied the effectiveness of oxycodone and gabapentin, which both effectively treat pain associated with nerve damage.
The participants were divided into three groups and received oxycodone, gabapentin, or placebo. Patients, whose average age was 66, had moderate to severe pain. All patients also received an antiviral medication, which is standard treatment for patients with the infection.
The team found that oxycodone was quite effective. Patients taking the medication, which is sold as Oxycontin but is also available in other formulations, were more than twice as likely to experience a meaningful reduction in their pain – at least a 30-percent decrease – compared to their counterparts taking a placebo. Though the medication was effective, nearly one-third of the participants on oxycodone withdrew from the study, mainly because of problems with constipation.
The team was surprised that gabapentin did not appear useful to treat pain. Dworkin said it’s possible that a higher dose would be necessary to adequately treat shingles pain. But the medication must be increased over the course of three weeks or more, which is often too long to have much of an effect on a fast-moving infection like shingles that can run its course in a few weeks.
The team chose to study oxycodone and gabapentin because they are often effective for treating patients in whom the severe pain of shingles persists for months or even years.
Release Date: March 25, 2009
Source: University of Rochester Medical Center