Preventing long-term pain from shingles
Press release issued: 4 April 2022
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 Centre for Academic Primary Care, 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.” A list of participating GP surgeries is on the study website.
The study is funded by NIHR Health Technology Assessment. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care (DHCS).
About the Centre for Academic Primary Care
The Centre for Academic Primary Care (CAPC) at the University of Bristol is a leading centre for primary care research in the UK, one of nine forming the NIHR School for Primary Care Research. It sits within Bristol Medical School, an internationally recognised centre of excellence for population health research and teaching.
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About the National Institute for Health Research (NIHR)
The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.