Spinal cord injury and shingles

AskNurseLindaAskNurseLinda Posts: 55Moderator, Information Specialist Information Specialist
10 Comments 5 Awesomes Reeve Staff 5 Likes
edited February 11 in Medical Issues
One of the secondary complications of spinal cord injury is a decreased immune response or the ability to fight infection from within the body. This can be an issue for everyone with a spinal cord injury but especially for those who develop spinal cord injury due to an infection in the nervous system or those who later develop infections due to the spinal cord injury itself.

We tend to talk about the body and the things the body does by discussing its separate systems. In reality, all of the body’s systems work together. Each system affects the others in some way. Not all connections are fully understood. Since the body is so complicated, it is easier to look at the separate elements. However, crossover functions occur. This exquisite working of the body is what makes it so fascinating and challenging. Something that affects one system of the body will affect every other part in some way.

Last week we discussed the prevention of colds and flu. Colds and flu temporarily overwhelm the function of the immune system in the ability to destroy the bacteria or virus that cause them. However, you certainly feel the results of a cold or flu in every other part of your body with aches, fever, runny nose, sluggishness, and the list goes on. That is a good example of how a disruption in one system, in this case, the immune system, can affect every part of your body.

What happens when you have a disruption in one system of your body, such as spinal cord injury and a second disruption in the same system? When two disruptions in the nervous system occur, it is considered a double injury. For example, peripheral nerves are the nerves in the body outside of the brain and spinal cord. Two injuries to a peripheral nerve are called a double crush injury. Interestingly, a double crush injury can have a better outcome than a single injury as, at the time of injury, the two issues together have significantly increased dysfunction. Recovery can have an improved result as one injury will unmask recovery in the other.

Spinal cord injury can be caused by trauma or, more often, from medical conditions. Some medical conditions are from blood clots or malformations such as stroke or vascular misconnections in the spinal cord. Other medical conditions leading to SCI can start from infections in the nervous system such as Transverse Myelitis or Gillian Barre Syndrome. Some diseases such as Parkinson’s disease (PD) or multiple sclerosis (MS) can have resulted in the spinal cord and brain.

In the central nervous system, two injuries have different effects depending on the location and source. One spot may cause difficulty whereas another spot does not. Another outcome is that several small spots of dysfunction can lead to a significant issue, but other areas of small spots do not. It all depends on the location of the injury. Some areas of the central nervous system are more easily compensated than other areas. Since disease typically occurs in a slower process, the body can learn to reorganize how messages travel as it adapts to changes with disease.

Whenever there is a change in the nervous system, other systems become affected. You can easily see this when bladder, bowel, and skin issues become apparent. You might not see cardiac issues immediately, but they may become apparent over time. One area that is difficult to see is the effects on is the immune system.

Several things happen to the body after spinal cord injury. The nervous system might not get a message that an infection is looming, so it does not activate the immune system to respond. The infection might multiply prior to recognition of its presence until it is seriously evident.  After spinal cord injury, the body activates a chronic stress mode because it cannot send and respond to the signals needed to create harmony within all of the different body systems.

The body is still working below the level of injury and appropriately sending messages to the brain, but these are interrupted by the spinal cord injury or misinterpreted by the brain, therefore proper response or recognition is not made. This puts the body into stress resulting in the over the release of random chemicals. It is like the flight or fight syndrome that is felt in psychologically stressful situations, but the body has no mechanism to halt it or to recognize it by the brain.

Shingle is a disease that lives in your nervous system if you had the chicken pox. Some people have a very mild case of chickenpox such that they think they never had it but most of us did have it at some point.

People who are most likely to get shingles are those who are over 50, had chicken pox and are immunocompromised either from immunosuppressant drugs (like prednisone) or from immunocompromising diseases (like spinal cord injury from trauma or disease). Shingles lives in your nervous system where you already have issues from your spinal cord injury.

Shingles follow the dermatome of your body. Those are the zones where your spinal cord injury is assessed when you have sensation testing. This test is the one where you are asked to differentiate between the cotton tip or a pinprick at different locations all along your body.  Shingles will follow one testing site around one side of your body (but it can be on both sides) as it travels along the nerve that exits your spinal column. Sometimes it follows a nerve on your head around to your eye.

Symptoms of shingles include itching and pain along the dermatome. You might not feel this symptom if you have a spinal cord injury. You might have general discomforts like fatigue, fever, and headache.  Autonomic Dysreflexia (AD) might be your first symptom as your body responds to shingles if it is below the level of your injury. After a couple of days to two weeks, you will see fluid-filled blisters. The blisters cluster along an imaginary line around the dermatome. You can have a lot of blisters, a few or even just a rash. 

Many people have shingles but don’t even realize it as the symptoms can be so mild. There are probably many cases like this that are not reported. However, the shingles stories that you hear about are the ones that are extremely advanced and painful. Since it is the nerve that carries the shingles virus, it is neuropathic nerve pain that is felt.

Shingles is treated with antiviral medication (acyclovir, valacyclovir, or famciclovir). These reduce the time and severity of the attack. Some people are treated with steroids (prednisone) but ask your health care professional about if you should take this drug due to your diagnosis of spinal cord injury because of the immunosuppression factor.

An interesting twist for individuals with spinal cord injury is that the pain medication that is provided for shingles pain is the same medication taken for spinal cord injury neuropathic pain, gabapentin (Neurontin) or pregabalin (Lyrica). So, if you are already taking this medication for neuropathic pain, you might not have effects of the severe nerve pain from the shingles virus. If you do not take gabapentin or pregabalin, you will probably start after shingles appear. Even if you are not feeling the pain from the shingles, your body is still reacting to it. Shingles pain is neuropathic pain. Even if the rash is gone, the pain can last for months. It does not always last long but it can.

For individuals living with spinal cord injury, you can see you have the risks factors especially immunocompromised, you might be in the age group and you may have had chicken pox. A good way to prevent shingles from occurring in your body is to obtain the shingles vaccination. The vaccination can reduce your chances of having shingles or if you do, it will reduce the time and severity of shingles outbreak. The vaccination is given in two doses within six months. Some people get a significant sore arm pain after the injections which can last up to a week.

As with any drug, therapy or treatment, be sure to ask your personal healthcare provider if this vaccination is right for you. I called the company to see if there was any contraindication for someone with spinal cord injury and was told no. However, be sure to check for your individual condition. If you have spinal cord injury from a virus or disease, this might not be right for you. Also, plan to have some extra help for time right after the injections due to arm pain or any other side effect. It might be difficult to transfer or propel your chair and, as always, monitor for AD.

Pediatric Considerations: Ask your healthcare professional about having your child vaccinated for the chicken pox virus. Many people think that because chicken pox is not often seen today, that it is no longer an issue. However, the virus is still out there. We don’t see it so often as many children are vaccinated for it. Keeping up with a regular schedule of childhood inoculations can prevent many diseases and complications for your child.

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Nurse Linda

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