Postherpetic neuralgia: symptoms, treatment and pain after shingles

Postherpetic neuralgia is nerve pain that lingers after shingles. It affects the areas of skin where the shingles rash was, and it carries on after the rash and blisters have healed.^[1][2] It’s the most common complication of shingles,^[3] and about 10% to 18% of people who get shingles go on to develop it.^[3] There’s no cure, but it usually gets better over time, and several treatments can ease the pain.^[1][2]

What is postherpetic neuralgia?

Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox. After chickenpox, your body doesn’t get rid of the virus. It stays inactive in certain nerves and can become active again years later, causing shingles.^[7] “Neuralgia” means nerve pain.^[5]

Postherpetic neuralgia happens when shingles damages nerve fibers. The damaged fibers can’t pass messages from the skin to the brain as they normally do. The messages become confused, and the body can’t manage pain signals properly.^[2] In Cleveland Clinic’s account, the damaged nerves over-signal pain to the brain.^[5] Nobody knows yet why some people keep having pain after shingles and others don’t.^[1][5]

How it’s defined

Health sources draw the line in different places. Mayo Clinic describes pain that lasts three months or longer after the shingles rash has healed.^[2] MedlinePlus defines it as pain that continues longer than a month after a bout of shingles.^[8] Symptoms usually start while you still have the rash or soon after it clears. In rare cases they start a few weeks or months after the rash has gone.^[1]

Postherpetic neuralgia symptoms

Symptoms show up in the same area of skin as the shingles rash. That’s often a band on one side of the body, usually on the torso.^[2] They may include:

• Pain that aches or burns, or feels sharp or shooting. It may be constant, or it may come and go.^[1][5]
• Very sensitive skin. Light touch, pressure or changes in temperature can hurt.^[1] People with it often can’t bear even the touch of clothing on the area.^[2]
• Itching, or numbness and loss of feeling in the skin.^[1][2]

The pain is often mild, but some people have severe pain.^[1] It can feel different from one person to the next.^[5]

Long-lasting pain can affect the rest of your health too. Mayo Clinic and Cleveland Clinic list depression, trouble sleeping, tiredness, eating less than usual and trouble focusing.^[2][5] How much this happens depends on how long the pain lasts and how bad it gets.^[2] Our guide to chronic pain and sleep has more on the sleep side.

Who is at risk?

Shingles is common. About 1 in 3 people in the U.S. will have it at some point, and there are about 1 million cases a year.^[9] You can only get postherpetic neuralgia after shingles.^[2] Shingles only happens in people who carry the chickenpox virus: from having had chickenpox, or in some cases from the chickenpox vaccine, which contains a weakened live form of the virus.^[10] More than 99% of Americans born before 1980 had chickenpox, even if they don’t remember it. The risk of shingles and its serious complications goes up with age, with conditions that weaken the immune system, such as certain cancers and HIV, and with medicines that suppress the immune system.^[9]

Once you have shingles, these things make postherpetic neuralgia more likely:

• Older age. The risk rises with age, and older adults tend to have longer-lasting, more severe pain. It’s rare in people younger than 40.^[3] Mayo Clinic says it mainly affects people older than 60, and Cleveland Clinic counts being over 50 as a risk factor.^[2][5]
• A weakened immune system, from a health condition, its treatment or other medicines.^[1][2]
• Severe shingles: a severe rash, a rash over a large area, or pain during the shingles itself.^[1][5]
• Where the rash was. A rash on the face or torso, or symptoms near the eyes.^[2][5]
• Other long-term conditions, such as diabetes or lung or heart conditions.^[2]
• Not being vaccinated for shingles.^[2][5]
• Not taking antiviral medicine within 72 hours of the rash appearing. See the prevention section below for what the research says about this.^[2]

How is postherpetic neuralgia diagnosed?

Most of the time, a doctor can tell from your symptoms, your medical history and a physical exam.^[5] They’ll check your skin and may touch it in different places to find the edges of the affected area. In most cases, no tests are needed.^[4] If you had shingles without a rash, or a rare type that affects the throat, your provider may order lab or imaging tests to be sure.^[5]

You might start with your regular provider, who may refer you to a nerve specialist (neurologist) or a doctor who specializes in long-term pain.^[4] It helps to note when the pain started, what makes it better or worse, and every medicine and supplement you take.^[4]

Postherpetic neuralgia treatment

Postherpetic neuralgia can be difficult to treat.^[1] No single treatment relieves it for everyone, and it often takes a mix of treatments to ease the pain.^[4] Finding what works can mean trying a few medicines in turn, or using more than one together. Every medicine here has side effects and can interact with others, so ask your provider to go through the risks.^[5]

Skin treatments

Numbing patches and creams. These contain a local anesthetic. You put the patch on the painful skin for short-term relief, and it can be cut to fit just the affected area. Some are prescribed, and lower-strength versions are sold over the counter.^[4] The numbing medicine also comes as a cream for areas where a patch won’t stay on.^[8] The NHS suggests these patches if your pain is mild or other medicines aren’t suitable for you.^[1] The research is thin. A 2014 Cochrane review found no good-quality trials of numbing medicine on the skin for nerve pain, though individual studies suggested it helped and clinical experience supports it for some people.^[11]

Capsaicin cream. Capsaicin comes from hot chili peppers. The cream is sold over the counter and may ease the pain. It can cause a burning feeling and irritate the skin, which usually fades over time. Mayo Clinic advises using a small amount the first time, wearing gloves to apply it, keeping it off areas without symptoms, and washing your hands afterward.^[4] UK guidance from NICE suggests capsaicin cream for nerve pain in one area when someone wants to avoid, or can’t tolerate, medicines taken by mouth.^[12]

High-strength capsaicin patch. A trained health professional applies it after numbing the skin. The visit takes at least two hours, because staff need to watch for side effects. The patch lowers some people’s pain for up to three months, and if it works it can be repeated.^[4] In a 2017 Cochrane review, two studies in postherpetic neuralgia found that about 10% more people said they were much or very much improved with the high-strength patch than with a low-strength one (moderate-quality evidence). The evidence on pain scores was very low quality, and the extra benefit was not large. Two of the reviewers reported paid work for drug companies, and Cochrane later found the review didn’t meet its newer rules on commercial sponsorship, though it met the rules in force when it was published.^[13] NICE says it shouldn’t be started outside specialist care unless a specialist advises it.^[12]

Medicines for nerve pain

Certain antidepressants. Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors (SNRIs) are among the first medicines providers try.^[5] They act on brain chemicals involved in both depression and how the body interprets pain, so they can help with pain even if you aren’t depressed. Providers often prescribe them at lower doses than for depression. Common side effects include sleepiness, dry mouth, feeling faint and weight gain.^[4]

Anti-seizure medicines (anticonvulsants). Some medicines for seizures also ease postherpetic neuralgia by calming injured nerves. Side effects include sleepiness, trouble thinking clearly, feeling unsteady and swelling in the feet.^[4]

For nerve pain in general, UK guidance from NICE recommends starting with one of four medicines from these two groups. If the first doesn’t work or you can’t tolerate it, the next step is to switch to another of the four.^[12] These medicines have to be taken every day and may take several weeks to start helping. If side effects bother you, don’t stop taking the medicine without talking to your provider first.^[8] The NHS notes that you’ll usually start on a low dose that’s raised gradually, with check-ups along the way.^[1] Cleveland Clinic’s list of first options also includes sodium channel blockers.^[5]

How well do they work? A 2017 Cochrane review looked at one widely used anti-seizure medicine. In postherpetic neuralgia trials, at the doses studied, 32% of people taking it got substantial relief (their pain at least halved, or they felt very much improved), compared with 17% on a placebo. The reviewers rated the evidence moderate quality, and noted that more than half of people who take it won’t get worthwhile relief but may still have side effects.^[14] Several of the reviewers reported consulting work or research funding from drug companies, including the medicine’s manufacturer, and Cochrane later found the review didn’t meet its newer rules on commercial sponsorship, though it met the rules in force when it was published.^[14] A 2015 analysis of 229 trials across many kinds of nerve pain found that results were generally modest, and that published trials tended to overstate the benefit. It still strongly recommended these antidepressants and anti-seizure medicines as first choices for nerve pain. Its authors listed ties to drug makers.^[15]

Everyday pain relievers and opioids

For mild or moderate pain, everyday pain relievers help some people, but they’re unlikely to relieve the pain completely.^[1] Talk with your provider before taking NSAIDs if you have heart disease, high blood pressure or kidney disease, or have had stomach ulcers or bleeding, and before taking acetaminophen if you have liver disease.^[8]

Opioids are strong prescription pain medicines. They raise the risk of addiction and death in some people, and Mayo Clinic says they should be prescribed for postherpetic neuralgia only if safer treatments haven’t worked. Before you start one, your provider should explain the benefits and risks, set goals for pain relief, and plan how you’ll stop safely if the risks become too high. Driving while taking an opioid can be dangerous, and it isn’t safe to combine one with alcohol or other medicines.^[4] The NHS says a doctor may prescribe one opioid for severe pain, usually only for a short time.^[1]

Procedures and specialist care

For long-lasting cases that are hard to treat, a provider may suggest nerve blocks, epidurals, spinal cord stimulation, or, less often, freezing the nerves between the ribs (cryoablation).^[5] A nerve block can reduce pain for a while,^[8] and steroid shots into the spine may help some people.^[4]

If your pain is severe, is affecting your daily activities, or hasn’t eased with medicines, you may be referred to a neurologist or a specialist pain service.^[1] NICE says referral can be considered at any stage, including the first visit, when pain is severe or significantly limits daily life or sleep.^[12]

Talk therapy

Cognitive behavioral therapy (CBT) is a common type of talk therapy for people with chronic pain. It may help you learn to cope with pain and manage how you respond to it.^[1][8] Our guide to the psychology of pain covers what CBT involves and how strong the evidence is.

Can postherpetic neuralgia be prevented?

The shingles vaccine

Cleveland Clinic calls the shingles vaccine the best way to prevent postherpetic neuralgia, because it lowers your chance of getting shingles in the first place.^[5] The CDC recommends two doses of the recombinant zoster vaccine (Shingrix) for adults 50 and older, and for adults 19 and older whose immune system is weakened by disease or treatment. There’s no maximum age. For adults 50 and older, the second dose comes 2 to 6 months after the first.^[16]

According to the CDC, two doses are 97% effective against shingles in healthy adults aged 50 to 69 and 91% effective in those 70 and older. Against postherpetic neuralgia, they’re 91% effective in adults 50 and older and 89% effective in adults 70 and older. In healthy adults 70 and older, protection stayed high for at least seven years.^[16] If you had the older vaccine, Zostavax, you should still get Shingrix. Zostavax is no longer available in the U.S.^[2]

In adults with weakened immune systems, Shingrix was 68% to 91% effective against shingles, depending on the condition. Side effects are common: a sore arm, redness and swelling where the shot went in, tiredness, muscle pain, headache, shivering, fever, stomach pain or nausea. They usually go away on their own in 2 to 3 days. Guillain-Barré syndrome, a serious nervous system disorder, has been reported very rarely after Shingrix.^[16]

The CDC says to wait if you have shingles right now, if you’re pregnant, or if you have a moderate or severe illness. People who’ve had a severe allergic reaction to the vaccine or any of its ingredients shouldn’t get it.^[16] The chickenpox vaccine helps too. Children who get it have lower rates of shingles than children who caught chickenpox, though the weakened vaccine virus stays in the body and can still cause shingles.^[10]

Antiviral treatment for shingles

Antiviral medicines shorten shingles and make it less severe. They work best when started as soon as the rash appears,^[9] and are most effective within 72 hours of the first symptoms.^[10] Mayo Clinic and the NHS both say early treatment lowers the risk of postherpetic neuralgia.^[1][2]

The trials are less convincing on that last point. A 2014 Cochrane review of six trials found high-quality evidence that one common antiviral, taken within 72 hours of the rash, did not significantly reduce postherpetic neuralgia at four or six months. There wasn’t enough evidence to judge the others.^[17] So get shingles treated quickly for its own sake, but don’t count on antivirals alone to prevent lasting nerve pain.

Evidence at a glance

Treatment	What the research found	Evidence	Source
High-strength capsaicin patch	About 10% more people much or very much improved than with a low-strength patch	Moderate	[13]
One anti-seizure medicine	32% got substantial relief, vs 17% on placebo	Moderate	[14]
Numbing patches	No good-quality trials; some individual studies suggested relief	Very low	[11]
Antivirals during shingles	No significant drop in postherpetic neuralgia at four or six months with one antiviral	High	[17]

Living with postherpetic neuralgia

Postherpetic neuralgia can limit everyday activities, make it hard to work, and affect how much you see friends and family. It can also bring frustration, resentment and stress, and those feelings can make the pain worse.^[8] The NHS suggests a few things that can help:^[1]

• Wear loose cotton or silk clothes so fabric doesn’t irritate your skin.
• Protect sensitive skin with a layer of bandage, plastic wrap or a plastic wound dressing under your clothes.
• Try an ice pack, or a bag of frozen vegetables, wrapped in a thin towel on the painful area for up to 20 minutes every 2 to 3 hours.
• Take cool baths or showers.
• Keep a daily pain diary to see how well a treatment is working and whether your symptoms are improving.

Relaxation techniques can help you relax and reduce the stress of long-term pain. MedlinePlus lists meditation, deep breathing, biofeedback, self-hypnosis, muscle relaxation and acupuncture.^[8] If the pain is wearing you down, a mental health professional can help with the emotional side of it.^[5] There’s more in our guides to relaxation and pain relief and lifestyle changes for pain.

Common questions

Does postherpetic neuralgia go away?

It usually does, but it can take a while. The NHS puts the range at a few months to over a year.^[1] Some people still have pain years later and a few are never completely free of it, though treatment can still help keep it in check.^[5]

Is postherpetic neuralgia contagious?

No. Postherpetic neuralgia is nerve pain that carries on after the rash has healed, and shingles can only spread while the rash is oozing fluid.^[1][6] Even then, nobody catches shingles itself.^[6] Someone who has never had chickenpox or the chickenpox vaccine can catch the virus from the blisters and get chickenpox.^[9]

Can shingles cause pain without a rash?

In rare cases, yes.^[6] The pain can also start before the rash shows up.^[2] Usually, though, the first tingling or pain is followed by a rash a few days later.^[6]

Can you get shingles more than once?

Yes, so the NHS advises getting vaccinated even if you’ve had shingles before.^[6] The CDC agrees: the vaccine can help prevent it coming back. Wait until the rash has gone before getting the shot.^[16]

Sources

1. NHS. Post-herpetic neuralgia. Page last reviewed February 24, 2025.
2. Mayo Clinic. Postherpetic neuralgia: symptoms and causes. July 10, 2026.
3. Centers for Disease Control and Prevention (CDC). Shingles symptoms and complications. April 19, 2024.
4. Mayo Clinic. Postherpetic neuralgia: diagnosis and treatment. February 10, 2023.
5. Cleveland Clinic. Postherpetic neuralgia. Last updated August 1, 2025.
6. NHS. Shingles. Page last reviewed November 23, 2023.
7. MedlinePlus. Shingles. Review date November 10, 2024.
8. MedlinePlus. Postherpetic neuralgia – aftercare. Review date April 10, 2026.
9. Centers for Disease Control and Prevention (CDC). About shingles (herpes zoster). Updated January 17, 2025.
10. Centers for Disease Control and Prevention (CDC). Clinical overview of shingles (herpes zoster). June 27, 2024.
11. Derry S, Wiffen PJ, Moore RA, Quinlan J. Topical lidocaine for neuropathic pain in adults. Cochrane Database Syst Rev. 2014;(7):CD010958.
12. National Institute for Health and Care Excellence (NICE). Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173). Published November 20, 2013; last updated September 22, 2020.
13. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1(1):CD007393.
14. Wiffen PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD007938.
15. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-173.
16. Centers for Disease Control and Prevention (CDC). Shingles vaccination. August 19, 2025.
17. Chen N, Li Q, Yang J, Zhou M, Zhou D, He L. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2014;(2):CD006866.
18. MedlinePlus. Suicide. Page last updated April 22, 2024.