Health Information Library

Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. It causes a burning pain in nerves and skin. The pain lasts long after the rash and blisters of shingles have gone away.

Postherpetic neuralgia mainly affects people older than 60. There's no cure, but treatments can ease symptoms. For many people, postherpetic neuralgia gets better over time.

Postherpetic neuralgia symptoms usually happen in the same area of skin where you had a shingles breakout. Often, a shingles rash looks like a band on one side of the body, typically on the torso.

Postherpetic neuralgia symptoms might include:

• Pain that lasts three months or longer after the shingles rash has healed. The pain may feel like sharp burning or jabbing. Or it may feel deep and aching.
• Being bothered when skin is touched. People with postherpetic neuralgia often can't bear even the touch of clothing on the area of skin that had the rash.
• Itching or loss of feeling. Less often, postherpetic neuralgia can cause an itchy feeling or numbness.

When to see a doctor

See a healthcare professional at the first sign of shingles. The pain of postherpetic neuralgia may start before you notice a rash. If you start taking virus-fighting medicines called antivirals within 72 hours of getting the shingles rash, the risk of having postherpetic neuralgia is lower.

The chickenpox virus causes shingles. If you've had chickenpox, the virus stays in your body for the rest of your life. The virus can become active again and cause shingles. This risk goes up with age. The risk also rises if something weakens the body's immune system, such as chemotherapy medicines to treat cancer.

Postherpetic neuralgia happens if nerve fibers are damaged during a breakout of shingles. Damaged fibers can't send messages from the skin to the brain as they usually do. As a result, the messages become confused, and the body cannot manage pain signals and pain levels. Pain can last months or even years.

With shingles, things that can raise the risk of postherpetic neuralgia are:

• Age 60 or older.
• Health conditions, treatments for an illness or medicines that make the immune system weak.
• Severe shingles rash that kept you from doing daily activities.
• Other long-term health issues, such as diabetes or lung or heart conditions.
• Shingles rash on the face or torso.
• Not taking antiviral medicine within 72 hours of the rash appearing.
• Not being vaccinated for shingles.

People with postherpetic neuralgia can develop other concerns that are common with long-term pain. It depends on how long postherpetic neuralgia lasts and how painful it becomes. Concerns may include:

• Depression.
• Trouble sleeping.
• Tiredness.
• Not feeling as hungry as usual.

Shingles vaccines can help prevent shingles. You can only get postherpetic neuralgia if you've had shingles.

In the U.S., people age 50 and older can get a shingles vaccine called Shingrix. Adults who have weakened immune systems due to disease or treatment also may get the shingles vaccine.

Shingrix is given in two doses, typically 2 to 6 months apart. With two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia.

Even if you've had shingles, being vaccinated can help prevent future breakouts.

If you've had the older shingles vaccine, Zostavax, you should still get the Shingrix vaccination. Zostavax is no longer available in the United States. Other shingles vaccines also are offered outside of the United States.

Ask your healthcare professional when you should get a vaccine and for more information on how to prevent shingles and postherpetic neuralgia.

To diagnose postherpetic neuralgia, a healthcare professional may first ask if you've had shingles and if your pain has lasted three months or more. Postherpetic neuralgia may be diagnosed by checking for pain in the area where you had shingles. For most people, no other tests are needed.

Postherpetic neuralgia treatment is used to ease postherpetic neuralgia pain and to make it go away sooner. Treatment also helps prevent other issues and improve quality of life. Postherpetic neuralgia has no cure, but it often gets better over time. No single treatment relieves postherpetic neuralgia for everyone. It may take a mix of treatments to ease the pain.

Lidocaine

Lidocaine is a treatment you put on the skin for short-term relief of mild postherpetic neuralgia pain. It comes in different forms, including creams, gels and small bandagelike patches. Your healthcare professional may prescribe lidocaine, or you can buy it without a prescription at lower doses.

Capsaicin

Capsaicin is a medicine put on the skin to relieve mild postherpetic neuralgia pain. You can buy it without a prescription for short-term relief.

It also comes in a high-dose skin prescription patch called Qutenza. You can only get Qutenza from your healthcare professional, who applies the patch to your skin. The process may take about two hours, as your healthcare team needs to watch for any side effects after the patch goes on. The patch may help relieve pain for up to three months. If it works, you can get a new patch every three months.

Anticonvulsants

Some medicines for seizures also may be used to ease moderate to severe pain from postherpetic neuralgia. Anticonvulsants calm injured nerves and may help with pain even if you do not have seizures. These medicines include:

• Gabapentin.
• Pregabalin.

Side effects may include:

• Feeling sleepy.
• Weight gain.
• Feeling dizzy.
• Not feeling steady when walking.

Antidepressants

Some depression medicines also may be used to ease moderate to severe pain from postherpetic neuralgia. These medicines affect key brain chemicals that play a role in how the body feels pain. In smaller doses, they may help with pain even when you do not have depression. These medicines include:

• Nortriptyline.
• Amitriptyline.
• Duloxetine.
• Venlafaxine.

Side effects may include:

• Weight gain.
• Feeling sleepy.
• Dry mouth.
• Feeling groggy or faint.

Opioid pain relief

Opioids are very strong medicines that a healthcare professional may prescribe for postherpetic neuralgia pain. These may include:

• Tramadol
• Oxycodone
• Morphine

Opioids can cause side effects such as:

• Constipation.
• Nausea.
• Feeling sleepy.
• It may be hard to breathe.
• Itching.
• Hormone issues.

An opioid may be prescribed for postherpetic neuralgia only if safer treatments haven't worked. Before you start taking an opioid, your healthcare professional may:

• Explain the medicine's benefits and risks.
• Set up treatment goals for pain relief.
• Make a plan to help you safely stop opioids.

Driving while taking opioids is dangerous. And it's not safe to take an opioid along with alcohol or other medicines. Talk with your healthcare professional if you are taking other medicines. Take the lowest possible dose of an opioid. And get checkups as often as your healthcare professional suggests.

Keep all prescription medicines and medicines you buy without a prescription out of the reach of children.

Injections

Postherpetic neuralgia may be treated with nerve blocks or shots, also called injections, into the spine and other painful areas. These treatments are used when medicines you take by mouth do not do enough to relieve pain. Shots may include:

• Cortisol hormone.
• OnabotulinumtoxinA.
• Epidural nerve block.

Other treatments

Some treatments send electrical pulses to your nerves to help control postherpetic neuralgia pain levels. These are called pulsed radio frequency and spinal cord stimulators. Acupuncture also may offer some pain relief, but additional research is needed.

An over-the-counter medicine called capsaicin cream may ease the pain of postherpetic neuralgia. It's made from the seeds of hot chili peppers. Capsaicin (Capzasin-P, Zostrix, others) can cause a burning feeling and may bother your skin. These side effects usually fade over time. But you should use only a small amount when you first try it to make sure you don't have bad side effects.

Try not to get capsaicin cream on parts of your body that don't have symptoms. Follow all the instructions that come with the cream. Wear gloves when you put it on, and wash your hands afterward.

You might start by seeing your family healthcare professional. You may be referred to a nerve specialist called a neurologist. Or your healthcare professional may suggest you see a doctor who specializes in treating long-term pain.

Here's information to help you get ready for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance. For instance, you may need to stop eating for a certain amount of time before you take a medical test. Make a list of:

• Your symptoms, including any that don't seem related to the reason for your checkup. Be sure to note when symptoms began.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins and other supplements you take, including doses.
• Questions to ask your healthcare professional.

Take a family member or friend along if you can. This person can help you remember the information you're given.

For postherpetic neuralgia, questions to ask your care team include:

• How long might my symptoms last?
• What treatment do you suggest? And are there other choices?
• I have other health problems. How can I best manage them together?
• Is there anything I shouldn't do while I recover?
• Should I see a specialist?
• Are there brochures or other printed materials I can have? What websites do you recommend?

Feel free to ask any other questions you may have.

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

• Do your symptoms happen some or all the time?
• How bad are your symptoms?
• Have you had chickenpox? When?
• Have you had a shingles vaccine?
• What, if anything, seems to make your symptoms better?
• What, if anything, seems to make your symptoms worse?