The S&A Health Report: The Most Painful Disease Imaginable – And How to Cut Your Risk of Getting it by Spending $160

“The world is full of suffering; it is also full of overcoming it.”

– Helen Keller

I was working in the walk-in clinic one day, and this old couple was in my exam room. On the chart, the triage nurse had simply written: “Severe pain for seemingly forever.” I couldn’t easily track down the nurse to confirm this so-called “chief complaint,” so I went into the room without more information. There, in the side chair, was an 84-year-old man and, in the exam chair, his young bride of 73. He was slouched over with a cheap baseball cap of umpteen years hiding his eyes and face. By the way he moved I could tell it took him a long time to get to the clinic. She was tilted to one side, moaning and rocking. The speed with which she moved confirmed that this trip had taken them both forever.

Ultimately, I was able to see on the right side of her body a zone of blisters and redness characteristic of her disease, known as shingles. This outbreak was right along her waist, where shirt and pants probably rub off a little of skin over the course of a day.

It turns out that shingles comes from the chicken pox virus, which most of us get as children. It is also called herpes zoster and, once exposed as children, we develop immunity to it, although the virus deviously regresses into and hides in our nervous system. There, the virus hibernates within the dorsal root ganglia in our spinal column. But, once we are older and our immune system is weakened or upset – WHAM – the most painful disease you could ever imagine crawls out of the spine, down the nerves, and attacks your skin. Sadly, the virus can do this over and over. Pain, regression, pain, regression, and so on. The skin rash and blisters this produces are truly the most uncomfortable disease you could ever have. It hurts when you move and it hurts when you are touched. People report pain of 10-out-of-10 simply when their clothes brush their skin. Other people report excruciating pain just sitting quietly. Many people have committed suicide over the pain.

The worse part about it, though, is that about 20% of those who get it never have regression and are stuck with perpetual and excruciating pain that lasts months, usually years. This is known as post-herpetic neuralgia and was why this sweet, old couple was there in my office. All he wanted was pain medicine, but there is no good pain medicine for this type of agony. Antiviral medicines don’t work well and most pain medicines are ineffective for unknown reasons. He simply wanted help to make her pain-free. But there was little we could do. I got teary-eyed watching them leave the clinic. They hobbled down the hall holding hands and were going to try a cream made from hot chili peppers (but that’s another story). There was little hope for people with zoster until last month.

Miraculously, just two months ago the FDA approved a vaccine for shingles and a panel recommended it for people aged at least 60 years. The vaccine is called Zostavax and it clearly cuts down both the pain and the actual occurrence of the disease. In a large, five-and-a-half year study of 38,500 men and women across 22 sites in the VA system, the vaccine was found safe as compared to a placebo. Of course, the usual complaints from a vaccine occurred: redness, swelling, pain, and irritation at the site of injection. Otherwise, this vaccine appears to be quite safe, and it reduces the pain and occurrence of the disease by at least 50%!

The good news is that the vaccine costs only $160. Relative to the pain and suffering this disease causes… this could be the best health-care money ever spent.

However, not every insurance company pays for it – although Medicare Part D has agreed to cover it with the usual co-pays. As it turns out, this vaccine will reduce pain and suffering in close to 300,000 people every year. This is money well spent.

When it comes to shingles... What do I do?

Here’s to our health and a happy, prosperous new year.

David Eifrig Jr., M.D., M.B.A.

P.S. For the investor in you… the vaccine is made by Merck.