Shingles: What You Should Know About the Sequel to Chickenpox with Dr. Jeffrey Brown

Podcast Transcript

Nada Youssef:   Hi, thank you for joining us. I'm your host Nada Youssef and you're listening to Health Essentials podcast by Cleveland Clinic. Today we're broadcasting from Cleveland Clinic main campus here in Cleveland, Ohio and were here with Dr. Jeffrey Brown, so nice to have you. Dr. Brown is a family medicine physician as well as an assistant professor at Cleveland Clinic Learner College of Medicine and Heritage College Osteopathic Medicine. Today, we're talking about shingles.

Before we get into topic I wanted to ask you some questions off-topic to get to know you better.

Dr. Jeffrey Brown:  Sure.

Nada Youssef:   Let's start with profession. If you weren't a physician today what would you be?

Dr. Jeffrey Brown:  Well, probably a teacher. I was already a software developer for 15 years before medical school, but ever since I was a little boy I just was fascinated with medicine. I spent some time in the hospital and saw some of the other children there, and realized that they were much sicker than me, and from that moment I just knew I wanted to be a doctor, but life takes you in different directions, and it just didn't work out at first, but the calling never left. I already did that, but if it weren't for medicine now I also love teaching. My father was a teacher, and a big part of being a doctor is teaching. Your patients, I teach the medical students, also our staff as well. I just like to explain things that I think are interesting.

Nada Youssef:   Great. How long were you in development?

Dr. Jeffrey Brown:  About 15 years.

Nada Youssef:   It's a nice transition you made. How about your best travel destination?

Dr. Jeffrey Brown: In general, I would say my best one is always going to be the next, but Hawaii was just wonderful.

Nada Youssef:   Did you go to Maui, or where'd you go?

Dr. Jeffrey Brown:  I went to Maui. I was actually visiting my brother in Tokyo and on the return trip ... which was also fabulous, but on the return trip why not stop off in Maui? It's the kind of place where you get off the plane and the air in the airport smells clean and everyone is friendly and smiling. Yeah, Hawaii is wonderful.

Nada Youssef:   Yeah, I've been to Maui, it is a beautiful place. How about a favorite all-time concert?

Dr. Jeffrey Brown:  Favorite all-time concert? I would say Jimmy Buffett just cause everyone's happy, or James Taylor because we sat in the front row, and it's a different experience no matter what show you're in when you're that close to the performer.

Nada Youssef:   Any upcoming concerts you want to go to?

Dr. Jeffrey Brown:  Well, I have a seven-year-old at home, so unfortunately concerts kind of go by the wayside for the next 10 years or so.

Nada Youssef:   Well, maybe take her to something.

Dr. Jeffrey Brown:  Oh sure, when she picks one I'll take her.

Nada Youssef:   You'll take her, okay. Great. Well, thank you. All right well, let's get into discussion. I want to talk about shingles. Let's, first, talk very general what are shingles?

Dr. Jeffrey Brown:  The simplest way to think of it is, it is a very painful rash that occurs mostly when you're 50, sometimes sooner, but 50 is the turning point where people get shingles. It's painful, and it comes because you got chickenpox when you were younger.

Nada Youssef:   You have to have had chickenpox in your previous year to get shingles?

Dr. Jeffrey Brown:  Right. What happens is when you're a child, or adults can get chickenpox, but typically when you're a child you get chickenpox your body fights off the virus, but it doesn't get rid of the virus. The virus goes into hiding, and the place it chooses is right outside your spinal cord at the base of a nerve, and it just sits there quietly for years and years. We call that latency. Then, at some point when you get older, about 50 or even more so at 60 the virus decides to wake up, go for a walk, and that rash starts all up again, the pain starts all up again. I almost think of it as chickenpox the sequel.

Nada Youssef:   It's always an inactive virus that's always in your body after chickenpox?

Dr. Jeffrey Brown:  Right.

Nada Youssef:   What are the symptoms?

Dr. Jeffrey Brown:  Well, typically, it starts with pain. People often describe the pain as burning, or stabbing, or aching, sometimes an itch.

Nada Youssef:   The pain is located in a certain area, or you're talking about just like chronic pain?

Dr. Jeffrey Brown:  Yeah, a certain area, and that all goes back to the fact that, as I said, once your body fights off the initial chickenpox infection and the virus goes into hiding it picks a nerve or two, and that's what makes the whole episode of shingles, the pain and the rash, tend to be in a location because the virus starts out in a nerve, and when it wakes up it walks down that nerve, and the nerve goes in a very specific area. Classically, around your midsection, or your lower back from the back to the front. That's why you see a classic line because that's where the nerve goes, where the nerve goes is where the virus goes.

Nada Youssef:   There's certain locations that shingles pops up?

Dr. Jeffrey Brown:  Mm-hmm (affirmative).

Nada Youssef:   My family member got it on his neck, and he's not 50 by the way, so it comes also in your neck, is that right? On your head I heard it can also ... why is it only those certain locations, is there a reason?

Dr. Jeffrey Brown:  Well, it can be anywhere, but again because of the virus wanting to stick in a nerve, and the distribution of a nerve if it happens to go into hiding in the neck when it wakes up it goes down the neck. If it happens to go into hiding in the lower back it wakes up and goes around the lower back. Now, why lower back and midsection? We don't know, but it does tend to go those two places first, and then the head and neck can be another common location, but anywhere a nerve travels, you can get it on the arm, you can get it on the leg, it will go.

Nada Youssef:   Before the rash appears are the symptoms just pain?

Dr. Jeffrey Brown:  Right, but this again is something where shingles can be very variable. About 75% of people will get the pain first. You still have some people where the rash and the pain come together, you have some people where first you get the rash and then you get the pain, but the most common general presentation is pain for about 2 to 3 days in a specific area which can cause confusion because, let's say, that area is right over where your gallbladder is people think, "Oh my gosh, I'm having a gallbladder attack," but it's not, it's shingles. Then, three days later up comes the rash.

Nada Youssef:   It takes about three days when you have the pain for the rash to appear?

Dr. Jeffrey Brown:  Typically, yes.

Nada Youssef:   What does the rash look like? Is it just a normal rash, kind of bumpy, is it blistery? What does it look like, disgusting?

Dr. Jeffrey Brown:  It starts out bumpy, starts out as little red bumps, little red dots that are raised. Then, after about the course of 7 to 10 days the rash moves from red bumps, red raised bumps to blisters, and then the blisters scab over.

Nada Youssef:   Wow. That's every single shingles episode is going to get blistery in 7 to 10 days before it clears?

Dr. Jeffrey Brown:  The vast majority, yes. The whole point of this discussion is to talk about what to look for, and oftentimes in medicine there are things which ... your rash doesn't read a textbook, so you will find the bazaar case that doesn't appear like that, but yes the great majority of time pain first, 2 to 3 days, then a rash for about 7 to 10 days. That rash goes from red bumps to blisters, the blisters may pop open, then the blisters scab over.

Nada Youssef:   Once I have shingles once can it come back again?

Dr. Jeffrey Brown:  It can. About 1 to 4% of people will get it a second time.

Nada Youssef:   You get chickenpox first, and then you get shingles, and then you can get shingles again, so it's inactive, it just wakes up.

Dr. Jeffrey Brown:  You still never get rid of the virus, the virus goes to sleep.

Nada Youssef:   No cure for that?

Dr. Jeffrey Brown:  No cure for that.

Nada Youssef:   Now, how do I know if it's shingles, or just some other rash?

Dr. Jeffrey Brown:  This is the tricky part, what I mentioned where sometimes the rash it'll pick a spot on the body and you might think it's a gallbladder, you might think you're having a heart attack, so you really can't tell if it's shingles until the rash appears. Sometimes you may just say, "Hey, the pain is in that location, so maybe it's shingles," even before the rash, but it is that classic distribution. The fancy word is dermatomal pattern, so derm; skin, tome; where it goes. You will see this rash in that stripe like pattern.

In your relative who had it, it was on the neck, but it would not have been up on the forehead, or not likely because that's a separate nerve, a separate dermatome. It may go to one or two dermatomes together, but typically will not go lower back and neck.

Nada Youssef:   Depending on where that vein is travelling.

Dr. Jeffrey Brown:  Right, the nerve.

Nada Youssef:   Or, the nerve, I'm sorry. All right, so if I was vaccinated for chickenpox does that clear me from having shingles as an adult?

Dr. Jeffrey Brown:  If you were vaccinated for chickenpox, yes because you don't get the actual virus, so the whole point of shingles is it is the virus doing the work. Again, like I said, chickenpox the sequel like in a horror movie the monster comes along, you kill the monster, you get rid of the monster, and then years later he's back. If you were to Google you will find some extremely rare cases, like I said before viruses don't read textbooks. There was one single documented case of a child who got the chickenpox vaccine and then got shingles, one case that we know of, so for the most part if you get the vaccine no, you're not going to get shingles.

Nada Youssef:   I know this can get a little confusing, so I just wanted to, again, clarify, so if I don't even get chickenpox as a child then there is no way I'm getting shingles as an adult?

Dr. Jeffrey Brown:  Correct. Yes, however, and this is the big thing with shingles and when people have shingles we say, "Hey, Grandpa has shingles be careful, don't get around Grandpa." For one thing it's the blister stage, when the rash turns into blisters that's when you can transmit the virus.

Nada Youssef:   It's highly contagious when the blisters appear?

Dr. Jeffrey Brown:  Right.

Nada Youssef:   Before that, nothing, not contagious?

Dr. Jeffrey Brown:  Before that not contagious. Once it scabs over not contagious. Going back to your question before, if you never had chickenpox, someone has shingles, the blisters form, you touch the blisters, you can then get chickenpox.

Nada Youssef:   It's spread from the fluid from the blister onto someone else?

Dr. Jeffrey Brown:  Right.

Nada Youssef:   That does not sound pretty. Okay well, is it a life-threatening condition?

Dr. Jeffrey Brown:  It can be. Again, this is also where we're talking about rare cases, but yes.

Nada Youssef:   Mostly not?

Dr. Jeffrey Brown:  Mostly not, but mostly can cause an awful lot of pain, and this is why we're so big on the shingles vaccine is because you don't want to underestimate that pain. The pain tends to last about 3 to 5 weeks.

Nada Youssef:   Wow.

Dr. Jeffrey Brown:  Right. About 10 to 15% of people who get shingles that pain can go on for 3 to 6 months or more.

Nada Youssef:   Tell me they take something for that. For the pain, the rash is different, but then the pain.

Dr. Jeffrey Brown:  Right. That pain that happens later on. The initial pain we call that acute. Acute is the fancy word for happened right now and happened fast. Acute pain comes with the rash, the whole course tends to last about 3 to 5 weeks start to finish, but then the secondary pain is something we call postherpetic neuralgia.

Nada Youssef:   Postherpetic neuralgia?

Dr. Jeffrey Brown:  Right. The shingles virus, which is the same virus as chickenpox virus, is in the herpes family.

Nada Youssef:   It is, okay.

Dr. Jeffrey Brown:  It's not genital herpes, but it's almost like if you have a Toyota Camry and a Toyota Corolla, they're both-

Nada Youssef:   Not the same, but the same brand.

Dr. Jeffrey Brown:  Right. The shingles virus is the same family as the genital herpes virus which is why we say postherpetic. Postherpetic, you knocked down the virus a second time, but now this neuralgia, painful nerves and that nerve pain, which my father had, can be debilitating. People sometimes can't even wear a shirt because even though you might shake someone's hand, or touch them just the light brushing, movement alone will cause unrelenting pain.

Nada Youssef:   The pain on the second phase, you'd say, is more painful than when you have the rash?

Dr. Jeffrey Brown:  Yes. Now, that phase, as I said, is postherpetic neuralgia, which can can go 90 days or more, that's about 10 to 15% of people.

Nada Youssef:   There is a majority that do not get pain at all?

Dr. Jeffrey Brown:  Don't get that second pain, right. Still the 30 days, 3 to 5 weeks of the initial pain is pretty awful too. People can't go to work sometimes, and the point of the virus ... I'm sorry of the vaccine is to lessen your chances of getting shingles in the first place. You don't get shingles, you don't get that postherpetic neuralgia.

Nada Youssef:   Is there a reason or a cause for shingles, risk factors that we should know about?

Dr. Jeffrey Brown:  Well, of course, the biggest risk factor is having had chickenpox. I guess, again, just to summarize and put things in perspective again you're a child, you don't get the chickenpox vaccine, so you wind up getting chickenpox. Your body fights off the chickenpox, that virus then goes into hiding somewhere at the base of a nerve for years and years and years it does nothing, and just stays there quietly. Then, when you get older and your immune system gets a little bit weaker that's when the virus tends to wake up and say, "Aha, I'm gonna cause shingles." Your immune system does a pretty good job of keeping that virus at bay, making sure it doesn't do anything. Then, at some point in time, the virus realizes it can get around your immune system, so the biggest risk factors, of course, must've had chickenpox first. Second risk factor would be age. Children can get it. I treat children and-

Nada Youssef:   Oh, children do get shingles as well?

Dr. Jeffrey Brown:  About 0.26%, small.

Nada Youssef:   That is very small. Is that due to their immune system being pretty weak then?

Dr. Jeffrey Brown:  Mm-hmm (affirmative). Well, in most cases it's children that may be treated for leukemia, or have some other underlying condition that lowers their immune system, but every now and then just who knows why? It just happens to happen. Age is the biggest risk factor. Women tend to get it more than men, and African-Americans tend to get it less, so a risk factor would be being white. If you're a white woman over the age of 50, or really over the age of 60 you're really at the biggest risk.

Nada Youssef:   And a weak immune system?

Dr. Jeffrey Brown:  Mm-hmm (affirmative).

Nada Youssef:   Let's talk about some of the prevention and treatment. Of course, we have the vaccine, but let's talk about when you have the blister what do you do? There's rash meds, what kind of stuff do we get?

Dr. Jeffrey Brown:  Unfortunately, there's not much.

Nada Youssef:   There's not?

Dr. Jeffrey Brown:  No. When the rash first happens, or really when the pain first happens within about 72 hours we can give you a medicine called Acyclovir or Valtrex. These medicines help fight the virus. The unfortunate thing is they really do the most work within 72 hours, so if in the first 72 hours you can have the presence to say, "Oh, I think this could be shingles," get the Acyclovir. It will lower the severity of the disease, so everything will happen more quickly, the rash won't be as bad, the pain won't be as bad, your chances of this postherpetic neuralgia will be much, much lower.

Nada Youssef:   This is obviously prescription, right?

Dr. Jeffrey Brown:  Right.

Nada Youssef:   I guess, I'm just thinking of time. If I'm getting pain I don't know if it's shingles until the rash comes after a few days, so sometimes maybe I missed that window, right?

Dr. Jeffrey Brown:  Well, typically, if you get it within 72 hours of the rash is when it's best. You want to give it for those blisters form. Certainly, once you feel the pain, if you can do it then that would be best, but the problem then becomes someone thinks, "Oh gosh, what's this weird pain," then they go away for the weekend, then the rash appears, then 4 or 5 days go by, and at that point there's not a heck of a lot you can do.

Nada Youssef:   If you, as a child, did not get the vaccine, and you have chickenpox you should get the shingles vaccine?

Dr. Jeffrey Brown:  If you, as a child, had chickenpox yes, then as an adult you should get the vaccine.

Nada Youssef:   You should definitely get the vaccine, right?

Dr. Jeffrey Brown:  Right. If you did not have chickenpox as a child just stay away from people who have shingles.

Nada Youssef:   What do people do when they have shingles? When it's up the blistery stage, just cover it up?

Dr. Jeffrey Brown:  Cover it up, basically, yes. Make sure those blisters don't get in contact with anyone.

Nada Youssef:   Are there any people that should not get the shingles vaccine?

Dr. Jeffrey Brown:  Well, mostly people who have a very much reduced immune system, that's pretty much it. Now, this happens to be the second vaccine we have for shingles, and this vaccine actually does a lot better than the last one. The last one worked about 50% of the time, the new vaccine that you maybe have heard about SHINGRIX, will stop it 97% of the time.

Nada Youssef:   Wow. Okay, much better.

Dr. Jeffrey Brown:  Yes.

Nada Youssef:   Okay good.  Any home remedies? Natural remedies?

Dr. Jeffrey Brown:  Again, unfortunately, not much because as far as actually treating it well, you got to treat the virus, and we don't have much for that. Symptomatically, just to treat pain, to treat the rash, cold compresses just the cold soothing will work. Also, oatmeal baths can sometimes help. In general, I would say your body's own immune system does an amazing job, and we sometimes don't give ourselves credit.

There was a study done back in 1918 when a worldwide flu epidemic came about. They took a hospital, and they said, "This whole floor of people got the flu, you're gonna stay in bed, you're not gonna move, you're sick." They took another floor, they said, "You people once a day or twice a day get out of bed, go outside, walk around the courtyard, get back in bed." 80% of the people who walked lived, 80% of the people who didn't died just because we were allowing our body to do its job.

Nada Youssef:   Immune system is a huge thing?

Dr. Jeffrey Brown:  Oh yes.

Nada Youssef:   Then, I'm getting stress may be a factor for immune system, dietary, anything like that?

Dr. Jeffrey Brown:  Stress can definitely be a factor. Stress is an interesting thing because whether you're going through a really difficult time at work, maybe difficult family life versus someone who is, say, in a war zone with bullets flying over their head the response your body has and in how the situation is addressed is the same as far as the inflammation that happens, the adrenaline that goes, so stress can definitely be a big factor. There was also a study done which showed people who had head trauma, or injury to the head within a month of getting shingles were more likely to have the shingles appear on their head.

Nada Youssef:   On their head, wow.

Dr. Jeffrey Brown:  It's just one study, but it does show how stressed, yes, can play a big effect.

Nada Youssef:   Yes, stress seems to be a culprit to kind of everything not just most things. How about dietary remedies, is there anything you should not eat if you're on shingles?

Dr. Jeffrey Brown:  Not that I'm aware of other than just having a healthy diet.

Nada Youssef:   Yeah, for your immune system because it all relates.

Dr. Jeffrey Brown:  There's a great thing that I've seen in clinic is people often say, "I think I have gluten intolerance," a separate topic, but because and they're not. They say, "I don't care, I'm gonna go gluten-free anyway," and they feel better, much better. I don't think it's so much the gluten because they were not gluten intolerant, but our diets have so much in it that grandma wouldn't cook, and if grandma won't make it-

Nada Youssef:   Like what? Let's talk about it.

Dr. Jeffrey Brown:  Well, look at the back of anything. How many ingredients can you not pronounce?

Nada Youssef:   We don't even know what it is.

Dr. Jeffrey Brown:  Right. The amount of processed sugar, which again is a whole separate topic, but from just a very broad point of view if you only eat what grew in the ground within 50 miles, or 500 miles ...

Nada Youssef:   Okay good. Now, let me a few, now we talked about the second vaccine that came out, if you already had that first vaccine should you go for the second?

Dr. Jeffrey Brown:  Yes.

Nada Youssef:   Okay and if you've never had any should you just do second?

Dr. Jeffrey Brown:  Just do the second.

Nada Youssef:   Either/or, go get the second.

Dr. Jeffrey Brown:  Go get the second, yes. The second one is a two dose series, so you get the first dose whenever and then 2 to 6 months later you get the second dose. It can cause some mild fatigue, low-grade headache, it can-

Nada Youssef:   Flu-like symptoms?

Dr. Jeffrey Brown:  Not even flu-like symptoms, but yeah very, very low grade flu-like, I guess, you could cause it. Won't cause breathing trouble, flu is a breathing disease. I got the shingles vaccine and, I think, within 24 hours I just wasn't feeling great, wasn't feeling sick, wasn't feeling great.

Nada Youssef:   You just didn't feel yourself.

Dr. Jeffrey Brown:  Yeah, and then I realized all, I had shot yesterday. Then, the next day I was fine.

Nada Youssef:   Okay good. When I was researching this I saw a lot of myths and facts happening, and I wanted to have a little segment, myth or fact. I'm going to just bring it up, and you tell me if it's a myth or a fact, and explain your answer.

Dr. Jeffrey Brown:  Sure.

Nada Youssef:   Only older people get shingles?

Dr. Jeffrey Brown:  Well, myth. However, the vast majority of people get shingles. As I said before, a very small number of children can get it particularly if you are someone who has a suppressed immune system, so leukemia and HIV would be some in children, or other rheumatologic diseases particularly if they're on medicines that lower their immune system. Myth, it is not only older people. The vast majority are older people, but we've been seeing even 20s, and 30s, and 40s much more of a ...

Nada Youssef:   Increase in patients.

Dr. Jeffrey Brown:  Mm-hmm (affirmative).

Nada Youssef:   How about shingles is a rare disease?

Dr. Jeffrey Brown:  Myth. About 1.2 million people a year get shingles in the United States.

Nada Youssef:   1.2 million, wow.

Dr. Jeffrey Brown:  Worldwide, depending on which report you read, anywhere from 30 to 50% of people in their lifetime will get shingles if you don't get the vaccine.

Nada Youssef:   Should people go to their primary physician and just ask for it?

Dr. Jeffrey Brown:  Well, you can actually just go to a pharmacy.

Nada Youssef:   You can go to a pharmacy and get it done there?

Dr. Jeffrey Brown:  Yeah. Your pharmacist is a doctor, a doctor of just drugs.

Nada Youssef:   A doctor of medicine.

Dr. Jeffrey Brown:  Yeah.

Nada Youssef:   Great. How about, I feel like we answered this, but you can get it more than once?

Dr. Jeffrey Brown:  Right, 1 to 4% of people will get it a second time, but the second time you get it, it will be a less severe outbreak than the first time.

Nada Youssef:   Then, stress can trigger it?

Dr. Jeffrey Brown:  Stress can trigger it, yeah.

Nada Youssef:   How about this one, it can cause vision loss?

Dr. Jeffrey Brown:  It can cause vision loss.

Nada Youssef:   It can?

Dr. Jeffrey Brown:  Yes.

Nada Youssef:   That's terrifying. Is it depending on the location, say, if it's on your head?

Dr. Jeffrey Brown:  Right, it's depending on the location. When it appears around the eye, and the biggest warning sign of this is if the rash starts appearing, and you get one of those little bumps on the tip of your nose that correlates with a much higher incident of possible vision loss.

Nada Youssef:   The tip of your nose?

Dr. Jeffrey Brown:  The tip of your nose.

Nada Youssef:   You're saying the rash ends up on the tip of your nose?

Dr. Jeffrey Brown:  Well, not just the tip of the nose. It will be there and spread around other parts of your face. Something else that I didn't mention before with what does it look like, because the rash goes into hiding in the nerve base just outside the spinal cord it will, the vast majority of the time, only be one side of the body. If you ever Googled a rash you will see lots pictures of people who have it on their face, and it's very clear it just goes right down the middle, and stops there, and will stop around the top half of the face, if it's going to involve the eye. It has to do with, again, what nerve the virus decides to settle down in after chickenpox, and if that happens to have been one of the cranial nerves, the nerves that come from the brain and then go out, a nerve called the trigeminal nerve, then it will possibly effect your vision.

Nada Youssef:   Then, the nerves going into your face are only one sided, they don't touch the whole face?

Dr. Jeffrey Brown:  Well, it's not that the nerves don't touch the whole face it's that the virus picks one.  You have two nerves, two nerves around the back, two nerves around the face, and the virus is just picking one of them, and that's where it presents.

Nada Youssef:   Very good to know. A lot of information. How about well, here's the next one, it can hurt or affect your brain?

Dr. Jeffrey Brown:  It can.

Nada Youssef:   It can?

Dr. Jeffrey Brown:  Yes.

Nada Youssef:   How does it affect the brain?

Dr. Jeffrey Brown:  Well, again, another rare presentation of shingles, and most commonly in people who are immuno suppressed, but usually when we talk about shingles we talk about the virus getting in the nerve that goes from the spinal cord away from the spinal cord.

Nada Youssef:   Starts there, but it goes away from there?

Dr. Jeffrey Brown:  Goes away from it down the arm, down the chest, or lumbar, but sometimes it can start there and go the other way. It's when it goes the other way that it can work its way up into the brain. Even chickenpox can be life-threatening.

Nada Youssef:   My question is this, when you talk about the pain that's associated with shingles, the chronic pain that I read a lot about, is this chronic pain through pain throughout your whole body, or just in that location for those weeks that you were saying, and what do people do about that kind of pain?

Dr. Jeffrey Brown:  That pain is in that location. It stays in that location where the rash was. What do you do about the pain, is a really tough one. Depending on which sites you read, the National Institutes of Aging do recommend make medications like Gabapentin or Neurontin, something called a tricyclic antidepressant.

Nada Youssef:   Antidepressant?

Dr. Jeffrey Brown:  Yeah, it's a form of antidepressant that can help with pain. Pain, just in general, is very, very difficult to treat. As you may know, there's an opioid crisis that we've been trying to address. Well, something like shingles the official recommendations for the National Institute of Health don't recommend opioids, but this is a kind of pain where, akin to cancer, sometimes opioids are needed. We, obviously, try to avoid them as much as possible, but they do work better than just about anything else.

Nada Youssef:   It's pain, pain is pain.

Dr. Jeffrey Brown:  Right, but in some forms of pain, in many forms of pain opioids don't help. Shingles is a finite period of time, so that's why we say that the opioids may be okay. We're not expecting someone to need the opioids for years and years and years because the shingles tends not to do that.

Nada Youssef:   All right well, we're running out of time, but is there anything else you want to tell her audience, or viewers, listeners of what to do? Should they go get their vaccine? Any kind of prevention tips?

Dr. Jeffrey Brown:  Sure. I guess, just to reiterate that the shingles vaccine definitely helps. Shingles can be awful, it can be painful, and we have a very good way now to prevent it. We just went through a whole series of myths versus truths, you can look on the Internet and you can find information on pretty much anything you want. The reality is that you're better off getting the vaccine than not. Can you search and search and search and hear someone tell you that a single child did get shingles after getting the chickenpox vaccine? One person that we know of. Does that mean you shouldn't get the shingles vaccine? No!

There are really three things that in all of history have really helped the health of people in the world and that is clean water, washing your hands, and vaccines. We have all sorts of medical advancements, all sorts of wonderful ways of treating people. When you talk about the 2 billion people on this planet those three things are the simplest things, and those have done more benefit than anything else we've got, so yes, vaccines. Some people don't like vaccines, that's a whole separate topic, but my take has always been you wouldn't argue about polio.

Nada Youssef:   Right. That's very true.

Dr. Jeffrey Brown:  If you're okay with polio hey, let's not get the pain of shingles.

Nada Youssef:   Right. Thank you. This is very, very informative. Thank you so much Dr. Brown for joining us, it's been a pleasure.

Dr. Jeffrey Brown:  My pleasure.

Nada Youssef:   For more information, or to make an appointment call 866-320-4573 or visit www.clevelandclinic.org/medicineinstitute, and thanks again for our listeners and viewers for joining us today. To listen to more of our Health Essentials podcast from our Cleveland Clinic experts make sure you go to clevelandclinic.org /hepodcast, or you can subscribe on iTunes, and for more health tips and information don't forget to follow us on Facebook, Twitter, Snapchat, and Instagram @ClevelandClinic, one word. Thank you so much for listening.