Shingles and Nerve Pain: Understanding Post-Herpetic Neuralgia

What is shingles?

Shingles is a painful rash caused by the reactivation of the chickenpox virus, which stays dormant in the body after a childhood infection. Years or decades later, often when the immune system is run down or with increasing age, the virus can reactivate along a nerve, producing a band of rash and pain on one side of the body. The rash usually clears within a few weeks, but the pain can sometimes linger. Shingles is not caught from someone with shingles, although a person who has never had chickenpox could catch chickenpox from contact with the blisters.

Symptoms of shingles

Shingles often begins with warning sensations before the rash appears:

• Tingling, burning or pain in one area of skin
• A red rash, followed by fluid-filled blisters, typically in a band on one side
• Itching and sensitivity
• Sometimes mild fever and feeling generally unwell

Because early antiviral treatment can help, it is worth seeking advice promptly when shingles is suspected, ideally within the first few days of the rash.

Why shingles can cause lasting nerve pain

The shingles virus inflames and damages the affected nerve. In most people the pain settles as the rash heals, but in some, particularly older adults, the nerve continues to send pain signals long after the skin has recovered. This lasting nerve pain is called post-herpetic neuralgia (PHN).

PHN can feel like:

• Persistent burning or aching
• Sharp, stabbing or shooting pains
• Extreme sensitivity, so that even light touch or clothing hurts

Our nerve pain explained guide describes how this kind of pain works.

Who is most at risk of PHN?

The risk of lasting nerve pain after shingles rises with:

• Older age
• More severe shingles or rash
• Delayed treatment of the initial episode

Managing shingles and its pain

During the shingles episode

• Antiviral medicines, started early, can reduce the severity and may lower the risk of lasting pain.
• Simple pain relief and keeping the rash clean and dry help comfort.
• Loose clothing reduces irritation.

Managing post-herpetic neuralgia

When nerve pain persists, ordinary painkillers are often not enough. Options a doctor may consider include:

• Medicines that act on the nervous system, such as pregabalin or duloxetine
• Topical treatments applied to the affected skin
• Referral to a specialist pain service for difficult cases

Pregabalin is a controlled medicine and should never be stopped abruptly. You can read our Pregabalin guide and browse the pregabalin range and wider pain range, but treatment should always be guided by a healthcare professional.

Prevention

Vaccination against shingles is available in many countries, particularly recommended for older adults, and can reduce both the chance of developing shingles and the risk of lasting nerve pain. Ask your doctor or pharmacist whether it is suitable for you. Looking after general health, managing stress and keeping the immune system in good shape may also help, although shingles can still occur in otherwise well people.

The emotional side of lasting pain

Living with persistent nerve pain can be wearing and is often underestimated by others, since there is nothing to see once the rash has gone. Low mood, poor sleep and frustration are common and understandable. Acknowledging this, seeking support and treating the pain properly are all part of recovery, and a doctor can help address the whole picture rather than the pain alone.

When to seek help

Seek advice promptly if you think you have shingles, especially within the first few days, as early antiviral treatment is most effective then. Seek urgent help if shingles affects the eye, if you have a weakened immune system, or if the rash is widespread. For pain that lasts beyond the rash, see your doctor about managing post-herpetic neuralgia. Browse our shop all range, but always seek professional advice first.

General information only — not medical advice. Always read the patient information leaflet and consult a doctor or pharmacist before starting any medication.