PHN on Left Chest

Hi Axis,

Not sure what is causing the pain on the opposite side of your chest, but PHN occurs only in the areas affected by the shingles.  Shingles affects only the sensory nerves, not the motor nerves or the spinal cord itself, so shingles itself cannot affect heart rhythms.  However, our emotional responses to the pain can affect the heart. 

Regarding meds, I've not had any help from ibuprofen or naproxen, and have not heard of anyone who has.  Cymbalta and Lyrica can be helpful, but as you say oral meds do have side effects.  Before I threw them all out I would be sure which ones cause which side effects.  It may be that, say, Cymbalta is tolerable but Lyrica isn't for you.  The folks on this site often say topical meds like Aspercreme or Dencorub help [both have salicylate], or lidocaine gel.  All available over-the-counter and pretty inexpensive.  Many folks here have reported good pain dampening from gabapentin, but it has sedation side effects that many complain of. 

I'd work with your doc on oral meds.  She/he may be helpful in teasing out which side effects are caused by which meds. 

Hope this is helpful, Axis.

Charlie

Not sure. My pain has only been where the shingles were in my head down to my eye.Never opposite side. Hope your doctor can help!

Hi Axis

In my case the pain from shingles covered a wide area around the chest and upper arm. It was mainly on one side, but did extend somewhat to the other side. When I realised it was neuralgia pain, with a transfer of pain to other parts of the body, I understood the problem. 

I remembered how a toothache caused my whole face to ache in sympathy, so I knew that the problem was the tooth, not the rest of the face. 

By treating the shingles area with a topical cream, I controlled the pain elsewhere, and gradually overcame the problem.

Please see my earlier posts, for the topical cream I have found to be most effective.

Kind regards, Ray.

I'm in the same situation. I normally defer to Charlie and others here, as they've got a lot of expertise but in this case I had the same concerns. I never really had the signature rash, and many people don't. I had a few tiny spots below my left breast and on my left back area. However, I often have pain that pops up on my  left upper shoulder, right back/shoulder area, right front and the middle of my chest/sternum area. I have also wondered, wow what if I have an actual heart attack! I bet the pain's very similar and I'll never know it..

My shingles was almost exactly a year ago, in the areas I mentioned. Since then I've been on gabapentin, a prescription NSAID I've been on for 30 years (which also helps the pain of PHN luckily) Asperecreme with 4% lidocaine and extra-strength Tylenol. At the worst, after increasing the Gab, I was at 2700 mgs (900 3X a day) 2 Extra-strength Tylenol every 4 hours (now I'm up to 5.5, yeah, I know that was a high dose, but I needed it), Aspercreme every 4-5 hours (4 times a day) and my NSAID twice a day. Now I'm down to 1500 mg, and take the Asperecreme and Tylenol 3 times a day. I've always felt that the nerves are like roots, they reach out thru almost the whole core area for us, or otherewise, there's some other medical connection. So yes, I get pain in other parts of my torso to, but not to the degree of where the shingles were.

Because the nerves are in the "core" reaching, bending, lifting, will all increase or set off the pain. Right now, I bet, it's hard to tell, as everything seems to hurt. But as I've had improvement, it's easier to isolate what  makes it worse. Bending to tie shoelaces activates the back AND front, so that's still extremely painful. Reaching into the freezer and trying to find that roast beef is terrible, you get the idea. I've learned to  try and limit myself, if I do too much lifting (grocery shopping, wash) I'm still in pain hours later.

I  had shingles  rash July 2017(in 60s) involving left upper chest extending around to front above nipple level.  This was preceded by a couple of weeks of left shoulder/scapula pain. It wreaked  havoc on my blood pressure with episodic flairs, atrial arrhythmia and severe left musculoskeletal chest wall pain.. I ended up with a cardiac cath which turned out ok. Since then, I have mild variable skin sensitivity, and persistent left chest wall musculoskeletal pain. This resulted in CXR and thoracic spine xrays which were ok.  I know this is only supposed to follow the  sensory dermatome pattern on the left, but this extended way beyond a one sided "skin" thing for me.  I wil have flairs of back pain, sternal pain, xiphoid pain and right rib pain with BP spikes in the worst episodes. Being treated as inflammation. This all started after the shingles. I have used low dose Neurontin and Tylenol arthritis.

?Its been 5 months now  and ongoing.  I cant tell for sure if the episodic flairs are aggravated by what I do(lifting, riding mower etc seem to aggravate) or if they are just going to happen.  seems to be every couple of weeks

I am an Anesthesiology trained Interventional Pain Physician who trained at the Mayo Clinic. 

There is an article in ASIPP Pain Physician magazine that reported early intervention with subcutaneous injection of Lidocaine 1% with Kenalog has significantly reduced pain from PHN shingles and also reduced the percentage of chronic pain from PHN (shingles). This procedure is very easy to perform and can be done by your primary care provider. 

The success of long term relief is based upon how early this modality of SQ injection of local anesthetic and steroid is performed in relation to the diagnosis/discovery of the onset of shingles.

Dealing with chronic PHN pain can be very difficult. As health care providers, we usually utilize oral medication such as Gabapentin, Lyrica, Cymbalta, or older TCA medications such as amitriptyline or Nortriptyline.  We sometimes prescribe Lidoderm or other topical agents such as capsaicin type of creams. These pharmacological agents seems to help some patients with various levels of success.

Sometimes, we perform fluoroscopic guided epidural steroid injections (ESI). If the pain is severe and intractable to less invasive treatment options, we sometime resort to dorsal root ganglion (DRG) or spinal cord stimulation (SCS). 

Information in this article is not to be construed as providing medical care. Please be aware that you should always seek guidance from your health provider for your medical treatment.  

Hope this helps.