For most people, the symptoms of shingles usually fade away along with the rash that may have appeared along one side of their body or face. But for some people, pain persists long after their skin has cleared.
It’s called postherpetic neuralgia, and it’s a complication of shingles. You might feel intense sensations of tingling, burning, and shooting that don’t let up. This could last for 3 months or longer, and you could be sensitive to touch and have trouble wearing clothes.
If you’ve had shingles and you’re hurting weeks or months later, talk to your doctor.
Why Does Postherpetic Neuralgia Happen?
Postherpetic neuralgia starts out with a very familiar illness: chickenpox. The virus that causes it is called varicella-zoster. Once chickenpox has run its course, the virus “hides out” in your nervous system.
Doctors aren’t sure exactly why, but sometimes the virus reactivates decades later and travels along pathways to your skin. A painful, blistering rash can erupt. That’s shingles.
In some cases, shingles can damage your nerves so that they can’t send messages from your skin to your brain as they usually do. That scramble of signals can trigger the ongoing pain of neuralgia.
If the pain lasts more than a year, it can become permanent.
Who Gets Postherpetic Neuralgia?
About 1 out of 5 people who have shingles will have these sharp, ongoing pains afterward. Certain things can increase your chances of getting it:
- Age: Most people who get postherpetic neuralgia are older than 60.
- Gender: Women seem to get it more than men.
- Early symptoms: People who have numbness, tingling, or itching before a shingles rash even appears tend to get the lingering pain later.
- Pain at the start: If you had severe pain or a rash during the beginning of your outbreak, you have a greater chance of the neuralgia later.
- Other health problems: People with ongoing conditions that can weaken the immune system, like HIV and cancer, seem more likely to get it.
What Does Postherpetic Neuralgia Feel Like?
You usually have pain on one side of your body, where you had the blisters. The feeling is described as shooting, sharp, or stabbing. Other signs you have neuralgia include:
- It hurts to be touched: Sometimes, you can’t bear clothing rubbing on your skin. You might feel discomfort from a light breeze.
- Long-lasting pain: This condition can last 3 months or longer after the shingles rash has healed. In some people, it’s permanent. For most, it gets better over time.
- Other sensations: Sometimes, you might feel burning, itching, tingling, or aching along with the shooting feelings. Some people feel numb or get headaches.
- You may also get a fever and generally feel worn-out.
What Can I Take to Feel Better?
Your doctor has a host of ways to treat your pain after shingles, including a variety of medications. They include:
Anticonvulsants: These medications were developed to control seizures, but they can also help reduce the pain of postherpetic neuralgia. Examples are:
Tricyclic antidepressants: These have been shown to help ease the pain of postherpetic neuralgia. They include:
Prescription painkillers: Over-the-counter medicine may be enough for mild cases, but others might need more powerful opioid (narcotic) painkillers, such as:
- Hydrocodone with acetaminophen (Lorcet, Lortab, Norco, Vicodin)
- Long-acting hydrocodone (Hysingla ER, Zohydro ER,)
- Hydromorphone (Dilaudid, Exalgo)
- Meperidine (Demerol)
- Methadone (Dolophine, Methadose)
- Morphine (Astramorph, Avinza, Kadian, MS-Contin, Oramorph SR)
- Oxycodone (OxyContin, OxyFast, Roxicodone)
- Oxycodone and naloxone (Targiniq ER)
- Oxycodone and acetaminophen (Percocet)
Talk to your doctor or pharmacist about side effects of any new prescription or over-the-counter medication.
Are There Treatments I Can Put on My Skin?
You might find relief with topical treatments. You can talk to your doctor about:
Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin and Zostrix. You can buy this over the counter but make sure your doctor knows if you plan on using these.
Patches: Capsaicin is also in Qutenza, which is applied via a patch for one hour every 3 months. You need to visit the doctor’s office for this.
Are There Other Ways to Ease the Pain?
Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include:
TENS (transcutaneous electrical nerve stimulation): You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.
Cold packs: Try a gel-filled one to numb the area unless cooler objects make your neuralgia worse.
Comfortable clothes: Go for looser fits and fabrics such as cotton and silk.
Can I Prevent It?
The FDA has approved two shingles vaccines, Zostavax and Shingrix. A vaccine is now recommended for everyone 60 and older. People from 50 to 59 may want to talk to their doctor about it if they have ongoing pain or skin issues or have a weakened immune system.
The vaccines cut the chance of shingles by at least 50%. Even if you still get shingles, the painful period is shortened and you reduce your risk of postherpetic neuralgia.
Early treatment for shingles can also lower your chances of getting this complication. So if you think you have it, call your doctor right away. The main treatment is with antiviral drugs during the early stages of shingles, within 2 to 3 days of symptoms coming on. Medications used include: