Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus that has lain dormant in the dorsal root ganglion after primary infection (as chickenpox). It affects the sensory ganglia and their areas of innervation, and is characterised by pain in the distribution of the affected nerve, and crops of clustered vesicles over the area. Pain may occur days before rash onset, or no rash may appear (zoster sine herpete), making the diagnosis difficult.
The annual incidence of herpes zoster varies with age, being very rare in children, occurring in 2-3 cases per 1,000 people in early adult life and in up to 10 per 1000 in those aged 80 years and over.(Dworkin 2001) The severity of the symptoms also increases with age.(Jolleys 1989) Some people suffer from post herpetic neuralgia after shingles, due to nerve damage.(Opstelten 2002) Acupuncture treatment of this is covered in another Factsheet (see Chronic Pain).
Conventional treatment involves giving an antiviral drug such as aciclovir, as soon as possible, to limit the damage caused by the herpes zoster virus. Corticosteroids may be used to reduce inflammation, and medication may be given to help with the pain, such as topical lidocaine.
Dworkin RH, Schmader KE. The epidemiology and natural history of herpes zoster and postherpetic neuralgia. In:Watson CPN, Gershon AA, eds. Herpes zoster and postherpetic neuralgia. 2nd Rev Edn. Vol. 11. Amsterdam: Elsevier; 2001; 39-64.
Jolleys JV. Treatment of shingles and post-herpetic neuralgia. BMJ 1989; 298: 1537-8.
Opstelten W et al. Herpes zoster and postherpetic neuralgia: incidence and risk factors using a general practice research database. Fam Pract 2002;19:471-475.
How acupuncture can help
Evidence from a systematic review of studies assessing the treatment of herpes zoster with acupuncture suggests that acupuncture therapy is effective for the condition.(Yu 2007) In a randomised controlled trial, electroacupuncture in combination with surround needling was found to be effective in facilitating crust formation and pain relief in patients with herpes zoster, and the effect was superior to that of medication.(Li 2009) Another randomised controlled trial found that acupuncture (surround needling) had a positive effect on cure rate in patients with herpes zoster, and that adding moxibustion to acupuncture improved the cure rate, and reduced the time to crust formation and the incidence of residual neuralgia.(Zhang 2007) (see Table below). There is very little research on acupuncture and shingles outside of China. Most of the trials to date are of low quality and the conclusions of the systematic review should be viewed in that light.
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010)
Acupuncture may help to relieve symptoms in people with herpes zoster by:
- stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz, 1987; Han 2004; Zhao 2008; Cheng 2009);
- reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
- enhancing natural killer cell activities and modulating the number and ratio of immune cell types (Kawakita 2008);
- increasing local microcirculation (Komori 2009), which aids dispersal of swelling.
However, we have yet to see physiological data specific to herpes zoster, and/or measured on patients with this condition.