Shingles appears on one side of the body as a band or belt-like shape. The rash occurs commonly on the chest, but it can also be found on the forehead, stomach, or almost any other part of the body. The pain associated with shingles can start a few days before the rash appears. Eventually, the blisters will heal and scab, but the pain may continue.
Other symptoms which may accompany shingles (depending on its location) include lymph node swelling, vision abnormalities, taste abnormalities, drooping eyelid, loss of eye motion, hearing loss, joint pain, genital lesions, and abdominal pain. Any lesions on the upper face (especially the tip of the nose) may show that the eye will be involved as well as the skin. In this case, there is a risk of chronic inflammation and loss of sight. If these symptoms appear, an ophthalmologist (eye doctor) should be contacted promptly. The early symptoms of shingles may include general symptoms such as headache, nausea, fever, and chills. It may also consist of pain, burning itching, or tingling on one side of the face or body. These early symptoms are very similar to the early signs of other diseases, and this is one reason why shingles is often misdiagnosed. Even some doctors can't tell the difference between shingles and other diseases, such as the flu, in the early stage. It is especially important to treat shingles at this early stage, because the longer one waits before getting treatment, the more chance one has of developing postherpetic neuralgia.
The pain associated with shingles commonly fades with time, but as noted, many patients-especially older patients-will have pain long enough to warrant a diagnosis of PHN. Many patients with this prolonged pain do get better spontaneously over time, but some do not and the pain becomes a chronic problem.
PHN pain occurs in the same area as the shingles. The skin in this area can have normal sensation, reduced sensation, or increased sensation. The pain may be continuous with fluctuating intensity, or occur in "spasms." The type of pain can vary:
- Spontaneous pain can be burning, throbbing, tingling, stabbing, piercing, shooting, sharp or aching. It can be accompanied by an intense itching in the area of pain.
- Pain can be produced by touch on the skin or change in temperature. This occurrence of pain from a stimulus that is not usually painful is called "allodynia." Some patients have severe sensory loss without touch-evoked allodynia. Some patients have severe pain and allodynia but little or no sensory loss.
- Sometimes, pain may extend beyond the area of the original shingles eruption.
People with PHN may also become depressed, worried, withdrawn and unable to sleep because of the pain (Irani, 1996). It is important that a patient reports these changes in mood and sleep patterns in order to get help that supports the process of healing. Because chronic pain often causes lack of sleep, sleep deprivation can contribute to a person's inability to do simple daily activities.