Dialysis — what it involves, what life looks like, and the difficult decision

Reviewed by a board-certified infectious disease and geriatric care specialist

If your parent had chickenpox as a child, the virus is still in their body, dormant in their nerve cells. In about one in three older adults, it reactivates as shingles, causing a painful, blistering rash that can lead to months of nerve pain even after the rash heals. Antiviral treatment works best when started early, and the Shingrix vaccine significantly reduces the risk. This is one of the more preventable sources of suffering in older adults.

A Virus That Waited Decades to Come Back

Your parent calls and mentions a rash on their side. They think they must have brushed against something, or maybe it's an allergic reaction. But the pain is unusual, they say. Sharp. Almost electric. By the time you hear about it, they're already in real discomfort, and when you see the rash in person, you recognize something your parent doesn't yet: this is shingles. This is the chickenpox virus, the one they thought was gone decades ago, emerging now as something far more painful and complicated.

For most of us, chickenpox was a childhood experience. You had it, maybe stayed home from school for a week, dealt with the itching, and then it was over. But the virus didn't die. It retreated into nerve cells in your body and stayed there, dormant, for decades. Chickenpox doesn't actually leave your body. It just waits.

According to the CDC, about one in three people who had chickenpox will develop shingles in their lifetime. The risk increases significantly after age 50. The NIH reports that nearly half of all shingles cases occur in people 60 and older, and the risk of the most debilitating complication, postherpetic neuralgia, rises sharply with age. The thought of your parent suffering through this, possibly for months after the rash has healed, is genuinely difficult. But understanding what's happening is the first step toward helping them through it.

How the Virus Works

Everyone who's had chickenpox carries the varicella-zoster virus in their body. After the chickenpox infection is over, the virus enters the nerve cells that branch out from your spinal cord and stays dormant. Your immune system keeps it in check, prevents it from reactivating. This balance holds for decades, usually for a lifetime.

But in older adults, the immune system's ability to keep the virus suppressed diminishes. Around age fifty and beyond, the risk increases significantly. By age eighty, about half of all people have experienced it at least once. Some people get it multiple times. If your parent had chickenpox, they're at risk.

What triggers reactivation varies. Sometimes it's stress, physical or emotional. Sometimes it's illness that temporarily weakens the immune system. Sometimes it's another health condition or a medication that suppresses immunity. Often, there's no clear trigger at all. One day the virus starts multiplying again, traveling down the nerve fiber to the skin, and your parent develops the classic presentation of shingles.

The risk is higher if your parent has other health conditions that affect immunity. Diabetes, rheumatoid arthritis, and some cancers increase risk. Medications that suppress the immune system increase risk. Simply being older increases risk.

What the Outbreak Looks Like

The onset of shingles is usually different from chickenpox. Your parent might feel pain, burning, or tingling in a specific area of the body for a few days before any rash appears. That pain can be mistaken for a pulled muscle or a nerve problem.

Then the rash appears, typically on one side of the body, following the path of a single nerve. It might be on the back, the chest, an arm, a leg, or on the face. The rash starts as reddened areas and quickly becomes a collection of fluid-filled blisters that leak, form crusts, and gradually scab over. This visual progression takes one to three weeks.

The pain is the defining feature, and it's often much worse than the chickenpox pain people remember. Your parent might describe it as burning, stabbing, throbbing, or electric. Some people have only mild pain, but others have pain severe enough to limit their ability to move, sleep, or concentrate. The pain comes from the virus inflaming and damaging the nerve itself. Even light touch on the affected area can cause significant pain.

Complications can occur. If the shingles appears on the face, especially near the eye, there's a risk to vision that requires urgent evaluation. The American Academy of Ophthalmology considers herpes zoster ophthalmicus an ophthalmic emergency. If it affects the ear area, there's a small risk of hearing loss. Some people develop secondary bacterial infections of the blistered skin.

For most people, the acute illness lasts two to four weeks. The blisters crust over, the crusts fall off, and the visible rash is gone. Your parent might feel weak or tired during the acute phase, and it takes time to regain full energy. But the acute outbreak ends. The more complicated part is what sometimes comes after.

Postherpetic Neuralgia: When the Pain Doesn't Stop

This is the part that's hardest to prepare your parent for, because it's not guaranteed and it's different for everyone. Postherpetic neuralgia is pain that persists in the area where the rash was, even after the rash has completely healed. The virus has damaged the nerve, and that damage doesn't always repair quickly.

In younger people, this lingering pain is relatively rare. In someone over sixty, it happens more often. The CDC reports that postherpetic neuralgia occurs in 10 to 18 percent of shingles patients overall, but the rate rises to 30 percent or higher in adults over 70. The pain can be anything from a mild background discomfort to something severely limiting. Some people describe it as constant burning, others as unpredictable sharp stabbing sensations, others as intense sensitivity where even clothing touching the skin causes pain.

This pain can last weeks, months, or in some cases years. There's no reliable way to predict how long it will last for your parent or how severe it will be.

The psychological impact is significant. After weeks of dealing with shingles, when the rash is gone and they should be feeling better, having the pain continue is demoralizing. It affects sleep, appetite, activity level, mood, and overall willingness to engage with life. When a parent tells you they're still in pain months after the rash healed, that's a real problem that affects their quality of life.

Treatment involves medications aimed at nerve pain, like gabapentin or pregabalin. Some people try topical treatments applied directly to the skin, like capsaicin cream. Others find different pain medications help. The approach is often one of trying different options to find what works best. For most people, the pain does gradually improve over time, even if it's slow.

Getting Treatment Early

The most effective approach to shingles involves starting treatment as early as possible. Antiviral medications like acyclovir, valacyclovir, or famciclovir can reduce the severity of the acute outbreak if started within 72 hours of when the rash first appears. They don't cure shingles, but they can shorten the duration and reduce the intensity of the pain. The earlier they're started, the more effective they are. The CDC and the NIH both emphasize that prompt antiviral treatment also reduces the risk of developing postherpetic neuralgia. This is why it matters to see a doctor quickly when you suspect shingles.

The antivirals come with some considerations. They require higher doses for shingles than for other conditions. Some side effects are possible, and for people with certain kidney issues, the doses need adjusting. But for most people, antivirals are safe and helpful.

Pain management during the acute phase is important. Over-the-counter pain relievers help some people. For more severe pain, a doctor might prescribe stronger pain medication. Sometimes topical treatments that numb the area provide some relief. Keeping the area clean and preventing infection is important while blisters are present. Loose, comfortable clothing that doesn't rub the area helps.

The acute pain phase passes. After that, the focus shifts to managing postherpetic neuralgia if it develops.

Prevention: The Vaccine That Actually Works

If your parent hasn't had shingles yet, there is something that significantly reduces the risk. The shingles vaccine, called Shingrix, is highly effective. The CDC reports that Shingrix is more than 90 percent effective at preventing shingles in adults 50 and older, and more than 90 percent effective at preventing postherpetic neuralgia. It's given as two doses, two to six months apart.

For people who've already had shingles, getting vaccinated still matters because it reduces the risk of it happening again. Yes, you can get shingles more than once.

The vaccine is not live virus. It can't give your parent shingles. It's designed to strengthen their immune system's ability to recognize and fight the varicella-zoster virus so that reactivation is less likely, or if it does occur, is less severe.

Medicare Part D covers Shingrix, and most private insurance plans cover it for adults 50 and older with little or no out-of-pocket cost. Your parent should check with their doctor or insurance about their specific coverage.

The vaccine is not perfect. Some vaccinated people still get shingles, though it's less common and usually less severe. But the protection is significant. For preventing a condition that can cause months of debilitating pain, the vaccine is one of the most straightforward preventive measures available.

If your parent hasn't been vaccinated yet, asking about it at their next doctor visit is worth doing. If they've already had shingles, they should ask about the vaccine to reduce the risk of recurrence. If you have aging parents and don't know their vaccination status, finding out and making sure they're protected is something concrete you can do that reduces suffering down the road.

Frequently Asked Questions

Can my parent get shingles if they never had chickenpox?
If they truly never had chickenpox, they cannot get shingles because the virus isn't in their body. However, many people had mild chickenpox as children and don't remember it. A blood test can determine whether the varicella-zoster virus is present. If your parent is unsure, the CDC recommends vaccination regardless.

Is shingles contagious?
Shingles itself isn't contagious, but a person with active shingles blisters can transmit the varicella-zoster virus to someone who has never had chickenpox, giving them chickenpox (not shingles). Once the blisters have crusted over, the person is no longer contagious. Keep your parent away from pregnant women, newborns, and immunocompromised people during the active blister phase.

My parent had the older shingles vaccine (Zostavax). Do they need Shingrix?
Yes. The CDC recommends that adults who received Zostavax should also receive Shingrix, as it provides stronger and longer-lasting protection. Shingrix replaced Zostavax, which is no longer available in the United States.

How quickly does my parent need to see a doctor when shingles symptoms appear?
As quickly as possible. Antiviral treatment is most effective when started within 72 hours of the rash appearing, though it can still help if started later. If your parent develops a painful rash on one side of their body, especially with burning or tingling that preceded it, they should see their doctor that day or the next.

Can shingles affect my parent's vision?
Yes. When shingles affects the forehead or area around the eye, it's called herpes zoster ophthalmicus, and it can damage the cornea, cause inflammation inside the eye, or lead to vision loss. If the rash appears near the eye, your parent needs to see an ophthalmologist urgently, in addition to starting antiviral treatment.

Is postherpetic neuralgia permanent?
For most people, it's not. The pain gradually improves over months, and most cases resolve within a year. A small percentage of people experience pain lasting longer than a year. Treatment with medications like gabapentin or pregabalin helps manage the pain while the nerve heals. The risk of prolonged postherpetic neuralgia is one of the strongest reasons to get vaccinated before shingles occurs.