Reflections from my experience with shingles

So I'm happy to report that my experience with shingles (active herpes zoster virus) has pretty much come to an end, with only very mild discomfort left in a small area of my back and abdomen.  I think I came through it all relatively well compared to some of the stories I heard during my experience.  It took about 3 weeks all total, probably another few days yet before the traces are completely gone.  I have to assume the anti-viral medication that was started early played a large part in keeping the experience contained.

While I would have been perfectly happy with my arm's length understanding of neuropathic pain, I will say that the silver lining to this experience was that, as a pain researcher, it's given me an opportunity to experience what many of my patients and study participants experience first hand.  I've had so many thoughts and musings on this subject that I'm not going to be able to remember let alone share them all here, but I'll touch on some of the more memorable ones.

I've now experienced allodynia (pain in response to a normally non-painful stimulus, like light touch) and thermal hypersensitivity personally.  And they're exhausting.  Trying to get the shower as close to body temperature as possible before hopping in, dreading getting dressed because I knew my clothes would be cooler than my body and will actually be genuinely uncomfortable for the first few minutes they're on, and trying my best to limit movements and prevent my clothes from rubbing on my skin.  I knew my thoracic muscles were in some degree of tone almost constantly, the muscle cramps were a good sign of that.  Add to that the fact that my immune system was working hard to get rid of this infection.  And I wouldn't say I was sleeping as soundly as I normally would.  Man, I was tired!

Another interesting thing I found myself frequently reflecting on was the way in which having a known pain condition affects your interpretation of other abnormal sensations in your body.  This is the crux of the illness representations model which I won't describe here, but is definitely worth learning about.  For example, a few days in I started experiencing really sharp pains in my left chest and a bit of achiness in my left arm.  Normally, one of the potential conditions that I would attribute such symptoms to would be some kind of ischemic heart condition (not that I've ever had heart troubles).  But in this case, meh, it must be the shingles.  Amazing how we are able to ignore what would otherwise be potentially dangerous warning signs by rationalizing the experience as part of a larger and obvious pain condition.  I wonder if that's a good thing or a bad thing?

 While the neuralgia associated with shingles is bound to be similar to other neuropathic pain conditions like complex regional pain syndrome or perhaps even whiplash if the recent literature is correct, the experience of shingles is different.  And there's a major reason for that - the rash.  I often find my patients with WAD or CRPS or other conditions not only have to deal with the unpleasantness of the condition itself, but also a level of stigma as they search for validation from health care providers.  I now know first hand that stress influences the intensity of unpleasant sensations from NeP, and stigma or 'social defeat' is a well known and very strong stressor, at least in rats.  But in the case of shingles, there is relatively little stigma - I went to my doctor who lifted my shirt, saw the rash, said 'yep, shingles', wrote me a script and off I went.  Five minutes tops.  My wife could clearly see it.  There was no doubt about what I was experiencing.

Patients will often tell you that they wish they would have broken something in an injury or accident, because at least then there would be evidence of their pain.  I've known people with chronic back pain who walked with a cane, not because they needed it, but because it was an outward symbol to the rest of society that they were disabled in the absence of other obvious signs.  This really speaks to the value of validating another's experience - saying 'I believe you are experiencing the symptoms you say you are experiencing', rather than searching for evidence to refute their experience, can be very powerful.

I'm sure I'll have other reflections about this as time permits.  But for now happy to report all clear and now moving forward.  Probably a good sign that it might be time to slow down though...