Emotional Stress and Shingles: How can we help

Shingles is a viral illness in which a painful rash develops. The rash can occur anywhere on your body although, it often appears as a stripe of blisters that wrap around the left or right side of your torso. The symptoms generally only affect a small section of one side of your body. 

Symptoms include:

• Sensitivity to touch
• An inflamed rash that begins after the pain
• Fluid-filled blisters that burst open and then typically crust over in 7-10 days and fully clear up within 2-4 weeks.

People can also experience:

• Fever
• Headaches
• Sensitivity to light (only when it affects the eyes)
• Fatigue
• Issues with eyesight (only when it affects the eyes)

Shingles are caused by the Varicella-Zoster virus, the same virus that causes chickenpox. It is also known as the Herpes Zoster virus. Anyone who has had chickenpox can develop shingles later in life. The Varicella-Zoster virus lies inactive in the nerve tissue near the spinal cord and brain, waiting for a trigger to set it off in the form of shingles.  

The most common complication of shingles is long term nerve pain called post-herpetic neuralgia (PHN). PHN can occur in areas where the shingles rash occurred. You may experience pain even after the inflammation settles. The pain can last for months or even years, significantly impacting the quality of life. Approximately 10-18 % of shingles sufferers will develop PHN, the risk increases as you get older. People below 40 years rarely experience PHN.

Shingles is a reminder that the mind and body are not separate. Essentially, emotional stress doesn’t cause shingles as we know the virus is already lying dormant in the body. However, emotional stress can weaken the immune system, reducing the body’s ability to defend against illnesses. Any number of stressors can lead to a weakened immune system. COVID fatigue, job pressures, and family situations are some stressors people face in the current climate, which can be challenging to cope with daily. We know that stress triggers a “fight or flight response”, a physiological reaction to an event. An acute stress response is triggered by a release in hormones, either prompting us to stay and fight or run to safety. In addition, the autonomic nervous system is stimulated during a stress response, prompting the release of adrenaline and cortisol into your body. The cortisol released during stressful situations can suppress the immune system’s effectiveness by lowering the number of lymphocytes. How we cope with stress differs for each individual. However, unhealthy coping mechanisms such as increased drinking and smoking are behavioural coping strategies that indirectly affect the immune system.

How is Shingles treated?

Like other viral infections, shingles will resolve on it’s own if left untreated. However, in specific clinical situations, a course of anti-viral medications can reduce the duration and severity of the shingles rash. In addition, it can minimise post-infection complications such as post-herpetic neuralgia (PNH). This is especially important if the rash affects certain parts of the body, the rash is causing severe pain and inflammation, or the patient is above 50 years of age or is immunosuppressed. The anti-viral medication is most effective if given within 72hours of the rash appearing. A course usually lasts for seven days and is generally well tolerated. Other helpful treatments include calamine lotion for the itch and painkillers to manage the pain. 

What can we do to help prevent Shingles?

Once you have had chickenpox, you will always be at risk of developing shingles. About 1 in 4 people will develop shingles in their lifetime, more commonly seen in people over 50 yrs. Some may develop shingles more than once. Of course, reducing the stress load on the body with healthy lifestyle choices can reduce but not negate this risk. So, another option to protect yourself from shingles is choosing to have the Shingles vaccine, which is included in the adult immunisation programme in the UK, USA and Australia, and many other European countries.

How is the Shingles vaccine given?

The current available shingles vaccine is called Shingrix and is given by intramuscular injection, usually in the arm. Two doses are needed, given 2 to 6 months apart. Shingrix is licensed for adults aged 50 years and older. 

What are the possible side effects of Shingrix?

Shingrix is usually well tolerated. Side effects tend to be minor and include pain at the injection site, generalised muscle aches, feeling tired, low-grade fever and headaches. Most side effects last 1-2 days and can be treated with rest and simple painkillers such as Paracetamol if this is needed.