Postherpetic neuralgia: what it feels like and what helps

Postherpetic neuralgia (PHN) is the lingering nerve pain some people get after a shingles outbreak. It can be sharp, burning, or like constant aching. For many, the rash heals but the pain stays, sometimes for months. If you’ve had shingles and the pain won’t quit, this page gives clear, practical steps to ease it and what to ask your doctor.

What causes PHN and who gets it?

Shingles happens when the chickenpox virus wakes up in nerve tissue. The virus damages those nerves, and that damage can keep sending pain signals long after the skin looks normal. Risk goes up with age — people over 50 are more likely to get PHN — and if the shingles rash was severe or treatment started late.

How to treat and manage pain

There’s no single cure, but several proven ways to reduce pain and improve daily life. First, if you still have active shingles, early antiviral meds like acyclovir, valacyclovir, or famciclovir given within 72 hours can lower the chance of PHN. If PHN has already started, your options include:

- Prescription nerve meds: Gabapentin and pregabalin often help nerve pain. They work by calming overactive nerves. Start low and follow your doctor’s dosing schedule to avoid side effects like dizziness or sleepiness.

- Tricyclic antidepressants: Drugs such as amitriptyline or nortriptyline can reduce nerve pain for some people. They aren’t for everyone — talk about heart issues and other meds first.

- Topical treatments: A 5% lidocaine patch placed on the painful area can numb it for hours. Capsaicin cream or high‑dose capsaicin patches reduce nerve signaling too, but they can sting at first and high‑dose patches are done in clinics.

- Procedures: For stubborn pain, options include nerve blocks, injections, or spinal procedures. A pain specialist can advise if these fit your situation.

- Simple at‑home strategies: Use cool packs to calm burning sensations or loose clothing to avoid rubbing sensitive skin. Gentle massage and short walks can help, but avoid exercises that flare pain. Sleep, stress control, and steady blood sugar also matter — nerves heal better when your body is rested and not starving or stressed.

If you’re choosing OTC or natural remedies, run them by your doctor to avoid interactions. And if medications make you drowsy, don’t drive or operate heavy machinery until you know how they affect you.

Prevention matters: the Shingrix vaccine cuts the risk of shingles and PHN dramatically and is recommended for most adults over 50. Ask your provider if it’s right for you.

When should you see a doctor? If pain is severe, getting worse, stopping you from sleeping, or you notice new symptoms like weakness, fever, or spreading redness, get medical help. A doctor can tailor treatment and refer you to a pain specialist if needed.

Want more info? Check our articles on antiviral treatment, nerve pain meds, and tips for living with chronic pain. You don’t have to just tolerate PHN—there are real options that can help you feel better and get back to normal life.