[Health Column] Early Symptoms of Shingles: How Are They Different from Muscle Pain? The 72-Hour Treatment Period and Post-Herpes Zoster

 

Hello. I am a specialist in Anesthesiology and Pain Medicine at Shintongbangtong Clinic. Oh Jin-seok no see.

 

You have likely experienced a sharp, stinging pain in your side or back for a few days, but seeing no visible abnormalities on the surface, you might have simply applied a pain patch, wondering, "Did I get a stiff neck?" or "Did I sleep in an awkward position?" Many people only realize they have shingles a few days later when red rashes and blisters appear in that spot.

 

Even in the examination room At first, I thought it was muscle pain. , I came to the hospital only after blisters formed. Is it too late? I often hear the same thing.

 

Today, I will explain in order how the early symptoms of shingles differ from muscle pain, why the timing of treatment is important, and what post-herpetic neuralgia, which many people are concerned about, is.

 

Q1. Why does shingles occur?

Shingles is the result of chickenpox that caused chickenpox in childhood. Chickenpox-herpes zoster virus This is the cause. Even after chickenpox has healed, the virus does not completely disappear from the body but remains quietly around the nerves; when immunity is weakened, it travels along the nerves and causes rashes and pain on the skin.

 

So, rather than shingles being a disease caused by being newly transmitted, A disease where a virus hidden inside my body becomes active again. It is close to that. It tends to occur as one ages, and when the body's defenses are weakened, such as due to overwork, lack of sleep, or after suffering from a serious illness.

 

 

In fact, according to data from the National Health Insurance Service, 722,257 people received treatment for shingles in 2021, with those in their 60s (23.8%) and 50s (22.4%) being the most numerous. However, as those in their 40s also accounted for 15.9%, it is not a disease that can be taken lightly simply because one is young. The Health Insurance Review and Assessment Service identifies summer (July) as the season to be cautious about shingles.

 

Q2. How can I distinguish the early symptoms of shingles from muscle pain?

The reason shingles is tricky This is because pain comes before the rash. A few days before blisters form, you may experience sensory abnormalities such as stinging or throbbing skin, or pain even from the slightest brush of clothing. Since there are no visible symptoms during this period, it is easy to mistake it for muscle pain, stiffness, or a herniated disc.

 

The characteristics that help distinguish them are summarized as follows:

 

division	Early pain of shingles	General muscle pain
Pain location	Appearing in a band-like shape on only one side of the body	Both sides or specific muscle areas
Pain patterns	stinging, burning, stabbing pain	Aching and heavy pain
skin sensation	Pain or sensitivity even from a slight touch	Skin sensation is generally normal
Relationship with movement	Pain regardless of posture or movement	It hurts more if you move or press.
Changes a few days later	Red rash and blisters appeared in the same spot	It gradually gets better with rest.
Accompanying symptoms	Body aches, headache, and a slight fever may occur together.	Generally none

 

💡 The key point is "One side of the body", "band-shaped", "pain that makes the skin sensitive" If you experience this pain and a rash or blisters appear in the same spot within a few days, you should consider the possibility of shingles.

 

Blisters usually last for about 2 to 3 weeks, then subside as pus forms and a scab forms.

 

Q3. Why is '72 hours' considered important?

The basics of shingles treatment is antiviral drugs Antiviral drugs are medications that inhibit the proliferation of viruses, so they are more helpful when used during the early stages of active viral replication.

 

According to data from Asan Medical Center, antiviral drugs Within 72 hours of the rash appearing When administered, it helps skin lesions heal, reduces the duration of acute pain, and lowers the risk of complications. This is why the 'golden time' for shingles is commonly referred to as 72 hours.

 

 

However, this does not mean that treatment is unnecessary just because 72 hours have passed. Even if time has passed, treatment may be required if new blisters continue to form, if the pain is severe, if the condition occurs on the face or around the eyes, or if the patient is elderly or has a weakened immune system. Don't just brush it off thinking, "It must be too late." It is recommended to confirm this through a medical examination.

 

Q4. What is post-herpetic neuralgia, and who should be careful?

What you are most worried about regarding shingles is Post-herpetic neuralgia It refers to a condition where pain persists in the same spot even after the skin rash has completely healed. Seoul National University Bundang Hospital explains that it is diagnosed as post-herpetic neuralgia when chronic pain continues for more than three months after the rash appears.

 

Because the virus travels along the nerves and damages them, the skin may clear up, leaving behind pain. Typical symptoms include burning or stabbing pain, and even the slightest touch of clothing can be painful; this pain can persist for months, or in severe cases, for years.

 

⚠️ Cases where you need to be extra careful about post-herpetic neuralgia
· In the case of the elderly
· Cases where acute pain and rash were severe
· If you are undergoing cancer treatment or have a weakened immune system
· Cases where shingles occurs on the face

 

Age has a particularly significant impact. According to data from Seoul National University Bundang Hospital, only about 10% of people in their 40s develop post-herpetic neuralgia, whereas it is known to occur in over 50% of those aged 70 and older.

 

 

Q5. What role does a nerve block play when the pain is severe?

While some people can control shingles pain well with medication alone, for those with pain severe enough to prevent sleep or those at high risk of post-herpetic neuralgia Nerve block We also consider it together.

 

Nerve block is a treatment that calms sensitized nerves by injecting local anesthetics around the pain-transmitting nerves. Seoul National University Bundang Hospital explains that performing a nerve block early after the onset of shingles is effective in reducing pain and decreasing the incidence of post-herpetic neuralgia.

 

In a comprehensive analysis of 39 randomized controlled trials by domestic researchers (Kim et al., 2021), continuous epidural block using local anesthetics and steroids, local injection therapy combined with antiviral agents, and paraspinal nerve block therapy were evaluated as effective methods for preventing post-herpetic neuralgia.

 

📌 Scene of an injection procedure performed while confirming the needle position with ultrasound

 

However, nerve blocks are not necessary for all patients, and their effectiveness varies from person to person. The necessity and method are determined by comprehensively considering factors such as the severity of pain, the time elapsed since onset, age, and medications currently being taken (especially anticoagulants). If the condition has already progressed to post-herpetic neuralgia, medication for nerve pain is used as the primary treatment, and nerve blocks are performed in conjunction depending on the patient's condition.

 

 

❓ Frequently Asked Questions

Q1. Is shingles contagious?

A1. Shingles itself is not contagious. However, since the blisters contain the virus, people who have never had chickenpox or have not been vaccinated can contract chickenpox if they come into direct contact with the blisters. It is recommended to cover the lesions until scabs form and to avoid contact with infants, pregnant women, and those with weakened immune systems.

 

Q2. If you get shingles once, can you not get it again?

A2. That is not the case. Since the virus remains in the body, it can recur if your immunity weakens. Even if you have had it once, it is advisable to consult with medical professionals regarding your health management and vaccinations.

 

Q3. Who should get the shingles vaccine?

A3. Vaccination is generally recommended for adults aged 50 or older, and those who have previously had shingles may also be vaccinated. Since the number of doses, intervals, and eligible recipients vary depending on the type of vaccine, you should determine the vaccine suitable for your age and health condition through a consultation during your medical appointment.

 

Q4. Is it okay to pop blisters or apply ointment when they form?

A4. Intentionally popping or scratching blisters can lead to secondary bacterial infection or scarring. Keep the lesions clean and dry, and it is safer to use ointments or disinfectants exactly as prescribed rather than using them arbitrarily.

 

Q5. Is it more dangerous if it appears on the face or around the eyes?

A5. If shingles occurs on the face, particularly on the forehead, around the eyes, or on the tip of the nose, extra caution is required as complications may arise in the eyes. If it occurs around the ears, it may be accompanied by facial paralysis or dizziness. If you experience a rash or pain in these areas, we recommend that you seek medical attention without delay.

 

Organize 🧭

Shingles is a disease caused by a virus remaining in the body that becomes active again when immunity is weakened. Because pain occurs before the rash, it is easily mistaken for muscle pain in the early stages, but Stinging pain appearing in a band-like pattern on one side of the body It has the characteristic of...

 

Starting treatment within 72 hours of the rash appearing helps reduce the duration of pain and the risk of complications. Additionally, for the elderly or those with severe pain, it is important to actively manage the pain early on to prevent it from leading to post-herpetic neuralgia.

 

However, pain on one side of the body does not necessarily mean it is shingles, and treatment methods and prognosis can vary from person to person. Please observe the pattern of pain and skin changes, and if you suspect any symptoms, consult with a medical professional to determine the appropriate treatment plan for your condition.

 

The skin heals in 2 to 3 weeks, but the pain remaining in the nerves can last much longer. Shingles is not a disease to be endured; it is better to detect it as early as possible.

 

📚 Reference Materials

· Asan Medical Center Disease Encyclopedia, "Herpes zoster"
· Asan Medical Center Newsroom (Feb. 20, 2025), "Can't Stand This! Everything About Shingles!"
· Bundang Seoul National University Hospital Health Information, "Treatment of Herpes Zoster Neuralgia"
· Kim J, Kim MK, Choi GJ, Shin HY, Kim BG, Kang H. (2021). Pharmacological and non-pharmacological strategies for preventing postherpetic neuralgia: a systematic review and network meta-analysis. The Korean Journal of Pain 34(4):509-533.
· National Health Insurance Service (Published April 2023), Shingles Treatment Status — 722,257 patients treated in 2021
· Health Insurance Review & Assessment Service, Disease Information in Statistics "Herpes Zoster"

 

 

Shintongbangtong Clinic

Director Oh Jin-seok

- Anesthesiology and Pain Medicine Specialist
- Fellow and Visiting Professor at the Pain Center, Catholic University of Korea Seoul St. Mary's Hospital
- (Former) Director of the Non-Surgical Treatment Center at OK Hospital
- Completed the Advanced Pain Management Course at the Korean Pain Society
- Completion of the Korean Pain Society's specialized interventional procedure training course
- Regular member of the Korean Pain Society and the Korean Spine Pain Society
- Current Director of Shintongbangtong Clinic