Nerve Pain Marks Shingles Onset Before Any Rash Appears

Shingles can start with intense burning along a nerve pathway before any rash becomes visible, according to two clinicians and an aging expert interviewed about the condition. Gerontologist Sam Cradduck said she has had shingles twice, both episodes tied to an autoimmune condition. "It burned. It's an infection in the nerve, essentially. It is nerve pain at the highest level," Cradduck said.

Cradduck said her pain settled in her back and flank, areas she could not see or reach. "Not something I could see, not something I could reach, but just an intense amount of burning. And then it came around," she said. She compared the sensation to a toothache traveling through the body. "You know how intense a toothache is. Now think about that in a pathway, in a nerve pathway in your body," Cradduck said.

Dr. Rhea Rogers, a board-certified physician, said the location of the pain follows a pattern that can be traced. "That's the clue to people. It's not like you're going to get a spot over here that hurts, and then the spot on the right side hurts. It's following what we call the dermatome of the nerve. So you can map out the nerve to see what's happening," Rogers said. She identified shingles as a reactivation of the virus that causes chickenpox.

Cradduck described the rash that followed her first episode as "very red, almost fiery red, but very close rash." Her second episode returned along the same nerve pathway and was less severe. "It is a crazy amount of pain," Cradduck said.

The timeline of her case runs through two infections, both linked by Cradduck to an autoimmune condition, with the second appearing on the same nerve route as the first. Rogers said age and health status influence how the virus behaves. "As you get older, your immune system is not as effective. So you can't fight things as well as you did, or if you're under stress or have autoimmune disease or anything that compromised immune system," Rogers said.

Aging expert Amy O'Rourke said she supports the shingles vaccine, which she described as a two-shot course. "The shingles vaccine, which I'm a real advocate for, is two shots. Some people forget to do the second shot," O'Rourke said. Rogers said the vaccine does not prevent the condition but can soften it if it develops. "It may make your symptoms much milder," Rogers said.

O'Rourke also described a friend whose shingles led to nerve pain in the eye that never fully resolved. "It didn't go away completely. Now he's on medicine to treat the eye nerve pain, and that has its own side effects," O'Rourke said. "So it's really a potentially long-term damaging disease."

Rogers said a strong immune system keeps the virus dormant. "It doesn't allow it to come out," Rogers said. She pointed to sleep and nutrition as ways to limit inflammation. "That comes back down to the basics. It's sleep, nutrition, all those different things help keep your immune system strong," Rogers said.

Cradduck tells people she meets about shingles using a house analogy. "It's kind of like having a bad houseguest that lives in the attic. And then every once in a while, it comes out and decides to wreak havoc, but only in one hallway. And then it goes back to the attic," Cradduck said. "It can choose a different hallway. It can choose a different nerve path." The vaccine course O'Rourke described requires a second shot that some patients skip.

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