University of Bristol: Preventing long-term pain from shingles

Researchers from the University of Bristol are recruiting patients with newly diagnosed shingles into a new study, to see if they can prevent the long-term pain which commonly persists after the rash has healed.

About one in three people get shingles, which causes a painful rash. People with shingles should be seen by their GP as soon as possible, ideally within three days. The rash goes after a few weeks but the nerve pain can last for months or even years. This is called “post-herpetic neuralgia”, it is difficult to treat and we don’t have any means to prevent it.

Doctors and researchers at the Universities of Bristol, Oxford, Southampton and Warwick want to find out if taking a tablet called amitriptyline can prevent persistent pain. They are looking for anyone newly diagnosed with shingles in the West of England, Wessex and Oxfordshire areas.

Patients, who are aged 50-years or older, can take part via participating GP surgeries. Everyone will be asked to take tablets nightly for ten weeks: half will be given amitriptyline and the other half will get placebo (or “dummy”) tablets. The research team will contact people and ask them to complete questionnaires, to find out what happens over 12 months.

Doctors have prescribed amitriptyline since the 1960s to treat depression. Originally it was used at high doses (75-150 mg) but nowadays it is used at low dose (10-30 mg) to treat nerve pain. In this study, the researchers are trying to find out whether low dose amitriptyline can prevent the nerve pain caused by shingles.

Professor Hazel Everitt, one of the GPs on the research team and Professor of Primary Medical Care at the University of Southampton, said: “Shingles is common and we currently don’t have any treatments that prevent the persistent pain that can last for a long time afterwards and be really troublesome. Common painkillers often don’t help and we need to seek new ways to prevent it.”

Matthew Ridd, GP and Professor of Primary Health Care at the University of Bristol, explains: “A small study published in 1997 suggested that taking a low dose of amitriptyline early on may prevent post-herpetic neuralgia. However this has never been confirmed in a large trial. We will do this in one of the largest trials of its type in the world. If starting amitriptyline early on does help, it is a cheap medicine that would prevent prolonged, difficult-to-treat pain for thousands of people.”

Lorelei Hunt, a patient with lived experience of post-herpetic neuralgia who is part of the research team, added: ”We need the help of 850 patients to help us in find out if we can prevent this nasty sting in the tail of shingles. So if you get shingles and your surgery is taking part, please help us if you can.”

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