Shingles is a painful rash caused by the varicella zoster virus, the same virus that causes chickenpox. The rash and pain associated with shingles occurs in a specific region on one side of the body and follows a dermatome pattern, which is the area of skin supplied by sensory nerves from a single spinal root. While the shingles rash itself is often very painful, many people also experience muscle pain and aches associated with the infection.
The link between shingles and muscle pain
The muscle pain and aches associated with shingles are likely due to inflammation caused by the virus affecting the sensory nerves that supply those muscles. Here’s a closer look at the proposed mechanisms:
- The varicella zoster virus lies dormant in the sensory ganglia after initial chickenpox infection. When reactivated, it travels down the nerve fibers to the skin, causing the shingles rash.
- Inflammation from the virus travelling down the nerves likely also affects the nerve fibers that supply deep tissues like muscles. This can lead to muscle pain and aches.
- Some researchers hypothesize that the virus itself may spread to muscle tissue and trigger inflammation.
- The immune system’s response to the virus reactivation may also play a role in muscle pain by releasing inflammatory chemicals.
In essence, the virus causes inflammation in the sensory nerves, and these same nerves supply sensation to the skin as well as deep tissues like muscles. This “cross-talk” is likely why shingles leads to both rash and muscle pain along the affected dermatome.
Common patterns of muscle pain with shingles
Muscle pain associated with shingles most often occurs in the region of the rash itself. However, it can also radiate along the dermatome more broadly. Here are some common patterns:
- Chest wall muscle pain when the rash affects the chest or upper abdomen.
- Intercostal muscle aches (between the ribs) with rash along the ribcage.
- Shoulder/upper back muscle pain with rash on the upper back or chest.
- Low back muscle aches with rash in the lower back/flank region.
- Headache and neck muscle pain when the rash affects the scalp or face.
In some cases, muscle pain can even precede the shingles rash, serving as an early symptom of reactivation. The pain is often described as sore, tender, or throbbing.
Other causes of muscle pain besides shingles inflammation
While inflammation of the sensory nerves is the prime suspect, other factors may contribute to shingles-associated muscle pain as well:
- Stress response: The body’s stress response to the virus can make muscles tense and painful.
- Fatigue: Shingles can cause fatigue that makes muscles ache.
- Nerve compression: Sensory nerves may become compressed as they exit the spinal cord, irritated by inflamed tissues.
- Referred pain: The “cross-talk” between nerves can create pain felt at a site distant from the actual injury (referred pain).
Can muscle pain occur without a rash?
It is possible to experience shingles pain without developing the telltale rash. This occurs when inflammation affects the nerve fibers but does not reach the skin. Known as zoster sine herpete, it can mimic other conditions like a heart attack, kidney stone, or pulmonary embolism depending on the dermatome involved. Muscle pain is often the main symptom, along with possible itching or tingling.
How long does the muscle pain last?
For most people, the muscle aches and pain associated with shingles improves as the rash heals. However, some continue to experience muscle pain even after the rash resolves. This is known as postherpetic neuralgia (PHN). Around 15% of people develop PHN after shingles. It results from long-standing inflammation and nerve damage. PHN can cause debilitating muscle pain for months or even years after the initial shingles infection has passed. Prompt treatment helps reduce the risk of developing PHN.
Treatment
Treatment focuses on relieving shingles pain, including muscle aches, speeding healing of the rash, and reducing complications. Key elements include:
- Antiviral medications: Drugs like acyclovir, valacyclovir, and famciclovir limit the virus and inflammation when started promptly.
- Pain medications: Over-the-counter options like acetaminophen, ibuprofen, or numbing creams can help ease pain.
- Prescription pain drugs: For severe pain, opioids or medications like gabapentin may be prescribed.
- Steroids: Corticosteroids help reduce nerve inflammation and pain.
- Antidepressants: Certain tricyclic antidepressants provide pain relief.
- Complementary therapies: Relaxation techniques, cold compresses, antiviral baths, and distractions help control pain.
With treatment, most patients see their shingles muscle pain improve within 7-10 days. However, prompt treatment is key, as delaying therapy over 72 hours from rash onset increases the risk of PHN. Seek emergency care if muscle pain is severe or accompanied by concerning symptoms like weakness, numbness, vision changes, or difficulty breathing.
Prevention
Two vaccines offer hope for shingles prevention by boosting immunity to varicella zoster:
- Zostavax – Approved for adults 50 and older, but only 51% effective.
- Shingrix – Over 90% effective and preferred for immunocompromised adults and those 50-59.
While not 100%, these vaccines significantly reduce the likelihood of developing shingles and subsequent nerve pain. They are recommended for adults over age 50, with certain people eligible at younger ages. Even for those who still get shingles, the vaccines tend to make it milder and shorter lasting.
Symptoms that should prompt urgent medical attention
While usually self-limited, shingles can sometimes lead to serious complications that require prompt medical care. Seek emergency treatment if you experience:
- Rash and pain in or near the eye (risk of vision damage)
- Lesions are hemorrhagic or necrotic appearing
- Severe muscle weakness or inability to use an arm or leg
- Loss of bladder or bowel control
- Significant motor deficits or numbness
- Severe headache, stiff neck, mental changes (risk of CNS issues)
- Difficulty breathing
Rapid treatment is vital to prevent permanent nerve damage and disability in cases of complications like Ramsay Hunt syndrome, transverse myelitis, or encephalitis.
Home care tips
Caring for shingles at home can help manage pain until symptoms resolve. Tips include:
- Keep lesions clean and dry to promote healing.
- Apply cool compresses to lesions to ease burning.
- Take lukewarm baths with colloidal oatmeal, baking soda, or vinegar.
- Apply calamine lotion to itchy lesions.
- Rest and pace activity to avoid pain flare-ups.
- Consider stress management techniques like yoga and meditation.
- Wear loose clothing over rash areas.
- Ask your doctor about taking antiviral and pain medications promptly.
With your doctor’s approval, over-the-counter pain relievers like acetaminophen, ibuprofen and topical numbing creams can also offer relief for muscle aches.
When to see a doctor
Consult a doctor right away if you experience a painful rash with blisters, especially if localized to one side of the body. Rapid treatment is key. Also seek medical care for:
- Uncontrolled pain
- Muscle weakness
- Rash near eyes or ears
- Significant swelling
- Lesions are worsening or spreading
- Fever above 100.4°F (38°C)
- Fatigue, headache or other concerning symptoms
Catching shingles early ensures the best outcome. While mild cases can be managed at home, doctors can provide important antiviral therapy, pain control, and monitoring for complications.
Conclusion
Shingles can cause significant muscle pain and aching due to inflammation of the sensory nerves supplying those muscles. Prompt antiviral treatment helps control the infection and limit nerve involvement. While temporary, muscle pain can sometimes linger in PHN. Seeking medical care within 72 hours of rash onset gives the best chance of recovery without residuals. With rest, proper care and medication, most muscle pain improves as shingles runs its course. However, severe or worsening pain warrants an urgent visit, as prompt care is key to avoiding permanent nerve damage and disability.