Postherpetic Neuralgia: Manage Long-Lasting Shingles Pain
After a shingles rash heals, some people keep feeling burning, stabbing, or electric-shock pain where the rash was. That lingering pain is called postherpetic neuralgia (PHN). It often starts after the varicella zoster virus reactivates as shingles and damages nerves. PHN can last months or longer and can really interfere with sleep, mood, and daily life.
What causes PHN and who’s at risk?
PHN happens when shingles injures sensory nerves, making them send pain signals even after skin looks normal. Doctors usually call it PHN when pain continues 90 days or more after the rash began. Age is the biggest risk factor—people over 60 are much more likely to get PHN. Other risk factors include a severe or widespread rash, shingles near the eye, and a weakened immune system.
Starting antiviral medicine (like acyclovir, valacyclovir) early during a shingles episode—ideally within 72 hours of the rash—lowers how bad the attack gets and reduces the chance of PHN. Vaccination with the Shingrix vaccine also cuts the risk of shingles and PHN by more than 90% in adults.
Treatment and self-care
Treatments aim to reduce pain and help you function. First-line prescription options include gabapentin and pregabalin—these calm nerve activity and often help within days to weeks. Tricyclic antidepressants such as amitriptyline or nortriptyline can work too, especially for constant burning pain. Topical choices are handy when pain is localized: lidocaine 5% patches numb the area, and high-concentration capsaicin patches (8%) can reduce pain for weeks after a clinic application.
If pills and patches don’t help, doctors may try nerve blocks, pulsed radiofrequency to the dorsal root ganglion, or neuromodulation approaches like TENS. Strong opioids are usually a last resort because of dependence and side effects. Talk with your clinician about the trade-offs and what fits your situation.
Simple self-care helps a lot. Keep the affected skin clean and loose clothing to avoid rubbing. Use cool compresses for sharp flare-ups and paced activity to avoid tiring yourself. Good sleep, short walks, and low-stress routines reduce how much pain affects your day. If PHN makes you anxious or depressed, behavioral therapy or support groups can improve coping and quality of life.
Diagnosing PHN is mostly clinical—your doctor will review your shingles history and examine the area. If pain is unusual or progressive, additional tests rule out other causes. Always mention side effects when starting a medication so doses can be adjusted.
If you had shingles, ask your provider about antivirals right away and about the Shingrix vaccine to prevent future episodes. If pain lingers beyond a few months, see a pain specialist or neurologist—early, targeted treatment gives the best chance to regain comfort and function.