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myasthenia gravis with shingles
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myasthenia gravis with shingles

My 80 year mother has myathenia gravis and got shingles 11/2 years  ago.  She
is in constant pain and has not left the house in all that time except for a couple Doc. appointments.  She can not wears a shirt because even that is too painful.  Fears all medications for the shingles because she is afraid it might affect the medications she is on for the MG.  Her last Doctors appointment they told  her she may have shingles for the rest of her life.  She also suffers from Depression, but will never admit to that, so telling her she may have it for the rest of her life was like adding fuel to the fire.  I would much appreciate your thoughts.
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your mother and obtain a history, I can not make specific treatment recommendations. However I will try to provide you with some useful information.

Severe pain persisting after shingles is called post-herpetic neuralgia, and as you describe above, can be debilitating. There are several treatment options for it, several of which do not significantly impact myasthenia, particularly if given at relatively low doses and titrated up slowly. These include corticosteroids (like prednisone, which as actually helpful in MG, though it can initially worsen symptoms), neurontin (gabapentin), lyrica (pregabalin), topical lidocaine patches, and duloxetine (cymbalta) which can help with the depression as well. As you many know, pain causes depression and depression causes pain, so treatment of any underlying depression is important. It would be important for her to followup with her neurologist, who can manage the shingles pain while paying attention to medications that might worsen myasthenia. Evaluation by a pain management specialist may be of benefit as well.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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