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Pain destroys the brain. Pain Doctor: “I See Human Dramas”

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The virus destroys neurons; like he ate them when we had shingles. A complication can be chronic pain, which can last for the rest of your life. Despite the use of all available methods, it is possible to reduce it only by 30-40%. Patients. The vaccine is a unique chance to prevent this, says Magdalena Kokot-Kempska, MD, president of the Polish Society for the Study of Pain.

Katarzyna Pinkosz, Wprost: Is shingles a disease that exists within us? As if we are sitting on a bomb that can explode at any moment because the virus is lurking in the body?

Dr. Magdalena Kokot-Kempska: Herpes zoster is an infectious disease manifested by the reactivation of a latent infection with the varicella zoster virus. After suffering from chickenpox, the virus “dormants” in our body and at some point may become active. 99 percent of the Polish population (including adults) have been exposed to the chickenpox virus. After illness, it is not excreted from the body.

Since the virus lies dormant in the body, is there a chance that it will never be activated again?

It’s true, it may never return and we won’t be able to get sick.

That’s what most of us think…

Most people still think that chickenpox is a mild disease, and that shingles is also a mild disease that has nothing to do with chickenpox. We do not realize that we have this virus inside us and that it can be activated when we are, for example, sick, weakened or have cancer. It can then get out of control of our immune system and cause the symptoms of shingles.

Why may pain persist after shingles?

The chickenpox virus destroys neurons; as if it were eating them, making holes in the myelin sheaths of neurons when we get shingles. The nervous system does not like to be damaged, touched or cut, which is why it reacts so violently to this damage.

It is clear why pain accompanies illness. But why do some people still experience pain even though the virus itself has been defeated by the body?

The virus has not been defeated. Even after recovery from the disease, the virus is still dormant and the immune system once again keeps it under control. We have many dormant viruses, such as the herpes virus. Almost all of us have had herpes (caused by a virus in the same family as the virus that causes chickenpox and shingles); every now and then it comes back—not because we get infected again, but because the virus lies dormant in the immune system and is reactivated when our immune system is weakened or we simply get older.

Does this mean you can also get shingles again?

Unfortunately, yes, especially in cases of weakened immunity.

You have been treating pain for many years. What is characteristic of postherpetic pain, so-called postherpetic neuralgia?

The pain is localized in the place where the skin lesions were with shingles. It’s not just pain, it can also be increased sensitivity to touch. Patients need to be careful with their clothing; women are irritated by bras and underwear. The pain usually worsens on cloudy and rainy days. This is also aggravated by stress.

However, this is not only pain; there is often increased sensitivity to temperature, tingling, itching, numbness – these are symptoms of damage to the nervous system.

You have a patient whom you have been treating for 30 years for pain from herpes zoster.

She contracted shingles when she was 60 and is now 90. She has been going to the pain clinic for 30 years—not because she was given the wrong medications or didn’t take them. I am treating her in accordance with the recommendations and all methods of modern medicine. But treating pain resulting from damage to the nervous system is very difficult.

We don’t know why this happens – there are probably many mechanisms of neuropathic pain that we can’t identify or don’t have a drug that targets such a mechanism. We use, among other things: antiepileptic drugs, antidepressants – effective in every third to four patients, i.e. in 25-30%. People. Even if we use the right medications, as recommended, in the right doses, the likelihood that we will reduce pain is approximately 30-50%. Please note: we will reduce pain, not cure it.

What about typical painkillers such as paracetamol, ibuprofen, ketoprofen?

They won’t work at all. Lidocalin patches may be effective for postherpetic neuralgia. But, unfortunately, they are effective only in every fourth patient. In some patients, despite the use of all drugs and methods available in world medicine, the pain cannot be eliminated or even reduced.

If patients coming to your clinic with postherpetic neuralgia knew about this disease, would they decide to get a shingles vaccine today?

More than 80 percent say yes and recommend vaccination to others. These are very suffering patients.

However, the problem is the cost…

Today, the vaccine is reimbursed by 50% for people over 65 years of age and with concomitant diseases. I believe that it should be free for all people at risk, including elderly patients. Suffice it to say that approximately 30 percent of patients who have had herpes zoster develop postherpetic neuralgia. But among people over 75 such people will be more than 70 percent! Therefore, all older people should be vaccinated.

The vaccine itself is recommended for all healthy people over 50 years of age, as well as people over 18 years of age if they have serious underlying diseases that lead to weakened immunity.

And if we’re talking about the cost of the vaccine, then on the other hand there are the costs of pain and its treatment, disability, the patient’s travel (often with a caregiver) to the pain clinic, and the cost of medications. I think these costs are much higher than the cost of the vaccine.

The pain may last for the rest of your life.

Do you have any doubts about the need for vaccination?

I have no doubts. I have worked in a pain clinic for over 25 years and have seen hundreds, if not thousands of patients with postherpetic neuralgia.

“I see the human drama of patients whom I have been treating for 5, 10, 15 years or more. In some cases, the pain seems to be under control, but after a while it returns. These people would not have to suffer so much if this vaccine had been available earlier.”

Older people are often afraid of vaccinations. How to convince them to do this?

For me, the best vaccine ambassadors are patients who themselves suffer from postherpetic neuralgia. They know from their own experience how serious and unpleasant the disease can be. Chronic pain, regardless of its cause, destroys nerve cells in the brain. Our brain seems to be atrophying, which is why depression, sleep disturbances, and cognitive disorders occur. This can be seen after 10-15 years of chronic pain. Patients suffering from chronic pain have a higher risk of developing dementia and Alzheimer’s disease. Pain destroys our brain. If it can be prevented, it should be done.

Magdalena Kokot-Kempska, MD, PhD, works in the Department of Pain Research and Treatment, Department of Anesthesiology and Intensive Care, Collegium Medicum, Jagiellonian University and is President of the Polish Society for the Study of Pain.

  • Prevention
  • Opinions and interviews
  • Infectious diseases

Source: Wprost

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