Shingles/Post-Herpetic Neuralgia


Shingles is a painful skin rash. It's caused by the varicella zoster virus. Shingles usually appears in a band, a strip, or a small area on one side of the face or body. It's also called herpes zoster.

Shingles is most common in older adults and people who have weak immune systems because of stress, injury, certain medicines, or other reasons. Most people who get shingles will get better and won't get it again. But it's possible to get shingles more than once.

Medicines can help limit the pain and discomfort caused by shingles, shorten the time you have symptoms, and prevent the spread of the disease. Medicines also may reduce your chances of developing shingles complications, such as postherpetic neuralgia (PHN) or disseminated zoster.

Postherpetic Neuralgia

Postherpetic neuralgia is pain, headaches, and nerve problems that occur as a complication of shingles (herpes zoster). Postherpetic neuralgia lasts for at least 30 days and can continue for months to years.

People who develop shingles after age 50 and who have severe pain and rash during shingles have the greatest risk for having postherpetic neuralgia. It most commonly occurs on the forehead or chest. The pain linked with postherpetic neuralgia may make it difficult to eat, sleep, and do daily activities. It may also increase the risk for depression.

Early treatment of shingles with antiviral medicines may prevent postherpetic neuralgia. If postherpetic neuralgia does occur, certain over-the-counter and prescription medicines can relieve pain.

Medicines to treat shingles when the rash is present (active stage) may include:

  • Over-the-counter pain medicines, such as acetaminophen or ibuprofen. These are used to help reduce pain. Be safe with medicines. Read and follow all instructions on the label.
  • Antiviral medicines. These are used to reduce the pain and duration of shingles.
  • Topical antibiotics. These are applied directly to the skin, to stop infection of the blisters.

Medicines to treat PHN pain may include:

  • Tricyclic antidepressants, such as amitriptyline.
  • Medicines put on the skin (topical medicines), such as creams or skin patches containing capsaicin or lidocaine.
  • Anticonvulsants, such as gabapentin or pregabalin.
  • Nerve block injections.
  • Tramadol and other opioids, such as codeine, oxycodone, and morphine.

For some people, over-the-counter pain relievers are enough to help control pain caused by shingles or PHN. But for others, stronger medicines may be needed. And if prescription medicines don't help control your pain, you may need to see a pain specialist about other ways to treat PHN.