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At Risk for Shingles and Postherpetic Neuralgia?

Experts explain the causes and treatments of shingles pain.

Early Intervention Is the Key to Treatment

Antiviral medicines such as valacyclovir (Valtrex), famciclovir (Famvir) or acyclovir (Zovirax), taken orally, are usually used to treat shingles. When taken at the very beginning, Ralph says, they can improve symptoms and reduce the risk of postherpetic neuralgia.

Starting antiviral treatment for shingles more than three days after symptoms start is generally believed to be ineffective because the virus is no longer reproducing. Still, many doctors will try treating the condition with antiviral drugs after this time.

An aggressive, early approach to controlling shingles pain may also reduce a person's chance of developing PHN. In one study, people who started taking amitriptyline (Elavil) for shingles pain as soon as a rash appeared had less pain after six months than those taking a placebo.

"Rapid initiation of treatment for shingles is very important," says Rumbaugh. "If treatment is started in the first three days, it can reduce the chance of postherpetic neuralgia and make it less severe if it does occur." This window of opportunity is often missed, however, because most people don't get to the doctor that quickly.

Postherpetic Neuralgia Treatment: Soothing the Pain

Once postherpetic neuralgia occurs, antiviral drugs can't treat the pain because ongoing infection isn't the problem. Instead, treatment aims to soothe and quiet the misfiring nerves that are creating the pain.

There are a variety of oils and creams available at drugstores. Some turn to herbal oils and creams, such as extracts from geranium, lavender, eucalyptus, tea tree, and bergamot.

Others use capsaicin cream, made from hot chili peppers. A drug called Qutenza contains "pure, concentrated, synthetic capasaicin," according to the FDA. Qutenza can be used every three months and is applied by a doctor via a patch or patches placed for an hour on the places on the skin that hurt. Before applying the patch, the doctor spreads a topical anesthetic on the area to be treated. 

Ralph said many people find relief from the anesthetic lidocaine, available in low-concentration creams or patches over the counter, or by prescription in higher concentration patches.

"The lidocaine soaks through the skin and numbs the painful nerve endings," says Ralph.  Lidocaine patches are particularly helpful for people with allodynia, Ralph adds.

If topical creams and oils don't provide sufficient relief, Ralph recommends asking your doctor about prescription medicines that may help, including some antidepressants, anti-convulsants, and opioids.

Postherpetic Neuralgia: Finding the Right Treatment for You

Experts agree that for everyone at risk, prevention is the best treatment. Although it's too early to see a benefit from vaccination in the community, Ralph believes that it shows promise.

For those who have postherpetic neuralgia, treatment needs vary widely. "Some people may only need a few months of a topical anesthetic," Rumbaugh tells WebMD. "Others -- not many, thank goodness -- take multiple medicines for the rest of their lives and still have pain."

Finding the right treatment for persistent postherpetic neuralgia can be a long and frustrating process. "It can take several weeks to really give a medicine a chance to work," Rumbaugh says. "If it's not working, you have to start all over again."

The important thing is not to give up. People with severe postherpetic neuralgia should see a neurologist or pain expert, says Rumbaugh. "There are people who think their pain isn't treatable, who simply haven't been tried on the right doses of the right medicines. There's usually something more we can try."

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Reviewed on December 06, 2011

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