instruction: hello doctor my mom has a pretty severe case of shingles starting on the left side mid back and goes around to the belly she has been prescribed pregabalin and it is not helping they tried gabapentin and she has bad side effects from it we have tried compounded pain ointments ice cool water etc nothing is helping she is 74 with late stage cold diabetic and has osteoporosis severely as well is there anything else we can do to try to ease her pain she is bellowing out in pain every minutes
output: hi shingles or herpes foster occur due to reactivation of chicken pox virus which hide in spinal nerve ganglion during childhood reactivation can occur in immunosuppression or old age thus it runs along a nerve in girdle like fashion it starts with fluid filled lesion which heal within unto weeks but nerve damage can give severe pain which may last longer it is called post herpetic neuralgia I hope there is no active fluid filled lesion if so kindly send a photo and renal function test report otherwise start so tablet pregabalin 25 my plus 1500 mug methylcobalamin tablet twice daily capsaicin or lidocaine patch application tablet tramadol if severe pain sos once daily calamine lotion thrice daily review after weeks it is sometime resistant other modalities like intraspinal steroid or botox injection can also be tried but let us fist see how this responds