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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Severe reaction of indescribable pain from application of

Customer Question

Severe reaction of indescribable pain from application of Capzasin for Shingles pain. Onslaught of Shingles about a month ago. Pain seemed to be getting better. However, followed directions of a PA to apply Capzasin after I could withstand pressure on my skin.
Current pain is horrible and has lasted for more than 5 hours. Ice packs help a bit.
Sincerely ***** ***** can suggest some relief as I am fearful this excruciating pain will cause permanent damage.
Becky Rutberg ***@******.***
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hello. Welcome to JA. What strength of capsaicin crème did you start out with? How large an area is involved in pain from the rash? Capsaicin acts by depleting the level of Substance P, a pain neurotransmitter from the nerve terminals in the skin. As that happens, pain generally increases in the exposed area. The concept is to stay with capsaicin, starting at low potency strength and increasing as tolerated until all Substance P is removed from the area, and then theoretically you should have no pain from that region. Capsaicin is not known to cause a permanent residual pain syndrome, but herpes zoster, the virus which causes shingles, is. So as bad as the pain is from using this product, I would suggest you start with the low potency crème, and use it for 2 weeks, before increasing strength, if you are able to tolerate the discomfort.

Expert:  Dr. Frank replied 1 year ago.

Alternatively, there is a new formula of gabapentin, called Horizant. It is a much more effective than gabapentin alone because of its base formation and is made especially for treating Herpes Zoster, and post-zoster neuralgia. If you have not tried it, I would suggest you contact your physician for a trial bottle. Alternatively, there are analgesic patches, like Lidoderm patch, that can be placed directly over the rash or area of neuralgic pain. That can help for up to 12 hours. Please get back to me to discuss this further if I can help. Ask questions and I will return a reply until you are satisfied. Once satisfied, please remember to rate my answer as that is how I am compensated for this work. Thanks *****

Expert:  Dr. Frank replied 1 year ago.

Hello if you need better pain control for PHN (post-herpetic neuralgia) get back to me as I can help. Please remember to rate my service as that is how I am compensated for my work. Click on the stars. Dr Frank