When is shingles pain the worst?

March 4, 2013 2:22 PM

I was diagnosed with shingles yesterday, with the first symptoms appearing 4-5 days ago. I have 14 Vicodin, and probably won't get more. When should I take them?

Right now the pain is annoying but mostly tolerable. I'm told it can become extremely bad, but varies from person to person. I'm a 37-year old male. Tylenol or Aspirin helps some, but Vicodin kils 100% of the pain. I'm trying to figure out if I should spread out the Vicodin evenly through the rest of the course of the disease (10ish days?) or save it for later if the pain will get worse then.

Last night I was able to get about 6 hours of sleep with just Tylenol. I'm told the pain is worse in the second week. Maybe I'll need all the Vicodin just to get through the night?

What was your experience? How was the pain distributed over time?

posted by jewzilla to health & fitness (19 answers total)

I would only take it if you absolutely need to, and would save them for night time, specifically. There is nothing worse than being miserable and exhausted but unable to sleep.
posted by something something at 2:28 PM on March 4 [5 favorites]

I had shingles last summer. For me the pain was the worst in the first few days of the rash, including some lymph node swelling under my arm that was uncomfortable.

The bad news is that shingles pain is neuralgia, and that kind of nerve pain doesn't respond very well to narcotics. The good news is that if you're a week into the shingles, you probably won't have pain much worse than what you have already experienced. If Tylenol is handling it for you, just use that (don't exceed 4000 mg/day).

Get well soon.
posted by little mouth at 2:29 PM on March 4 [1 favorite]

I contracted shingles in my early 30's. I was actually able to recognize what it was - fatigue followed by a blister on my torso - and went to the clinic within about 24 hours of onset to get an anti-viral which nipped it in the bud. So I'm wondering if you did that?
posted by KokuRyu at 2:30 PM on March 4 [1 favorite]

If you're mostly having issues with pain at night, have you asked your doctor about sleeping pills?
posted by ablazingsaddle at 2:34 PM on March 4

I can't help you with regards to shingles specifically, but last year I had to do a significant amount of pain management, and I have to say one of the most important things I learned was to keep ahead of the pain.

This means not waiting until the pain is so intense that you have to take your strongest pain med right now, but to know when the pain is starting to increase, and to take enough of the med to keep the pain bearable. If you let the pain get ahead of you, it will take even more vicodin, and even more time, to get it back under control.

I hope you hela quickly!
posted by blurker at 2:38 PM on March 4 [4 favorites]

Be very careful using Vicodin for your breakthrough pain if you're medicating primarily with Tylenol. Vicodin contains acetaminophen too so if you're not extra careful you could end up over the 4g daily limit.

I agree with blurker that you should stay ahead of the pain. If I were you I would probably do something like 325 mg Tylenol every four hours (that's one regular strength tablet), regardless of how you feel, and one Vicodin before bed at night.
posted by telegraph at 2:43 PM on March 4

Oh man, I am dancing around in my chair just remembering the discomfort, and it happened to me 5+ years ago. So you've got my sympathy (which, of course, with a quarter will get you a small pack of gum)

Anyway, the pain for me was worse at the beginning (probably about where you are now) and probably lasted about a week. If I was you, depending on how much it affects you, I'd take two Vicodin a day for a week - at night and sometime in the morning -- and Tylenol in between if necessary and within reason. (I'm also all about keeping ahead of the pain as well.)
posted by MCMikeNamara at 2:44 PM on March 4

I've had a few shingles outbreaks, and every one was different.

Just call the doctor if you're having pain; they're not going to think this is drug-seeking behavior (I mean, unless you have a history). Let them work with you.

Take what you need when you need it.
posted by kinetic at 2:44 PM on March 4

Chronic nerve pain sufferer checking in.

blurker is right, you don't want to use up all your meds, but you also don't want to wait until the pain becomes unbearable.

If I were you I'd consult with a pharmacist. In this case, for instance they might recommend you ask your doctor about a therapeautic dose of ibuprofen (1000mg) for 10 days. Or the pharmacist might just recommend you do it. It will combine with the vicodin and have a greater effect than the separate drugs combined

(Note: I am NOT recommending that you start gobbling up ibuprofen. I am not a doctor. I don't even know how to sound like I'm a doctor.)

How certain are you that you won't get more Vicodin? Your doctor might have told you that's all you're getting so that you'd be judicious in your use of the drug. So take it when you need it and call if you need more. They probably have patients who need more sometimes.
posted by vincele at 2:46 PM on March 4

And, of course, by "hela," I meant heal.

Sigh.
posted by blurker at 3:13 PM on March 4

Thanks for the advice so far. Just to clear up a few points:
- It is too late for antivirals.
- I'm very careful about my acetaminophen intake; liver damage sucks.
- I'm sure I could get more Vicadin, but the last thing I need is withdrawal symptoms when this is all over, so I want to be conservative about how much I take. I have no history of addiction.
posted by jewzilla at 3:26 PM on March 4

another +1 on blurker's 'keep ahead'

[erasing a big paragraph about inadequate care and taking your patient-ing business elsewhere on seeing the update] I would go and have another conversation with your doctor about better pain management strategies. You are really unlikely to have withdrawal issues or liver damage from medicating yourself through a bout of shingles and I think you are setting yourself up for an unnecessarily difficult ride by trying to tough too much out, which often does not mesh well with the 'keep ahead' idea -- but this is 'IANAD'/'IANYD' territory, I fear.
posted by kmennie at 3:40 PM on March 4

14 Vicodin is about a 2 day supply if you take 2 every 6 hours. You're a long way from needing to worry about withdrawal symptoms.

You can't get dependent on narcotics (physiologically) by taking them once or twice a day, because you won't have a steady concentration of the drug in your system - the drug wears off after about 6 to 8 hours. This is a short term issue. Treat your pain.
posted by treehorn+bunny at 3:41 PM on March 4 [2 favorites]

very good advice above.
it is good you are aware that vicodin contains acetaminophen...so be careful (as you are being) of combining it with tylenol. combining it with motrin, however, is ok.
treehorn+bunny is correct; in a person with acute pain and no prior history of addiction, it is unlikely that you are going to have any sort of withdrawal problem. Truthfully, I have found that the people who worry about that are much less likely to have an issue.
so...don't take the vicodin recreationally (duh), but also don't wait until you are in agony to take them. use adjunct motric. see your doc if what you currently have doesn't take care of your issue. stay well.
posted by maryrussell at 4:21 PM on March 4

My pain was minimal for all three of my instances of Shingles. The worst felt like a very bad bee sting or bug bite and this was before I saw any blisters. After the blisters appeared I had almost no pain. The second and third time I didn't even go to a doctor. I was twenty three the first time I got Shingles and in my early to mid thirties the second and third time.
posted by WalkerWestridge at 4:28 PM on March 4

If medical marijuana is an option for you, it can be extraordinarily useful for this kind of nerve pain.
posted by judith at 6:16 PM on March 4

FWIW I had two friends I worked with that were put on Valtrex after their shingles presented themselves. One had blisters on her face and one had the classic band of blisters around their waist. They both said it made a world of difference with the pain and blisters.
posted by PJMoore at 6:58 PM on March 4

Ask your doctor for Gabapentin. Gabapentin is specifically for nerve pain....this is what is causing you so much pain, and Vicodin may not be effective. I've had shingles twice (!) and Vicodin just puts me to sleep. good luck, I feel your pain.
posted by honey badger at 8:55 PM on March 4

You might ask your doctor for Lidoderm patches, local anesthesia applied to the skin that is supposed to work well for shingles. They are quite expensive but may be worth it.
posted by zoel at 6:19 AM on March 5