Neuropathy & Numbness
How Do You Treat Neuropathy?
Amarish Dave, DO explains the two goals of neuropathy treatment: identifying the underlying cause of nerve damage and treating the symptoms it causes.
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What Is Postherpetic Neuralgia? Why Nerve Pain Continues After Shingles
Shingles usually fades in a few weeks — but for some people, burning, shooting, or touch-sensitive pain continues long after the rash is gone. This is called postherpetic neuralgia (PHN), and it is one of the most common causes of nerve pain neurologists treat in older adults.
Written and medically reviewed by Amarish Dave, DO, board-certified neurologist. This page is educational and does not replace an individual medical evaluation.
What Is Postherpetic Neuralgia?
Postherpetic neuralgia is persistent neuropathic (nerve) pain that follows shingles. It is caused by injury and inflammation of the sensory nerves affected by the virus.
Shingles (herpes zoster) happens when the varicella-zoster virus — the same virus that causes chickenpox — reactivates years after a childhood infection. PHN commonly refers to pain lasting at least 90 days after the shingles rash begins, although definitions vary. The key point: pain can continue long after the skin looks normal again.
Why Does Shingles Cause Long-Lasting Nerve Pain?
- The shingles virus reactivates inside sensory nerve tissue.
- Inflammation and injury disrupt normal nerve signaling.
- Injured nerves can fire abnormal pain signals on their own.
- Pain-processing pathways in the spinal cord and brain can become more sensitive, amplifying discomfort.
- As a result, pain can persist even after the skin has healed.
Symptoms of Postherpetic Neuralgia
- Burning or searing pain
- Electric-shock sensations
- Shooting or stabbing pain
- Tingling
- Persistent skin sensitivity
- Pain from light touch (allodynia)
- Discomfort when clothing or bedsheets touch the skin
- Sleep disruption from ongoing pain
Symptoms usually occur in the same area as the previous shingles rash — often a band on one side of the chest or back, or one side of the face. Burning nerve pain has many other causes too; see peripheral neuropathy and why your feet may be tingling or burning.
Who Is Most at Risk?
- Increasing age, particularly after age 50
- A severe shingles rash
- Severe pain during the initial shingles episode
- A weakened immune system (immunocompromised status)
How Long Does Postherpetic Neuralgia Last?
Some people improve over weeks to months; others have pain for a year or longer. Recovery varies with age, the severity of the shingles episode, and individual factors, so no one can promise a specific timeline. Treatment can still make a meaningful difference in comfort and sleep while the nerves recover.
What Treatments Help Postherpetic Neuralgia?
Gabapentin
Oral medication that calms overactive nerve pain signaling.
Considerations: Dizziness and sleepiness are common; dose is started low and adjusted for kidney function.
Pregabalin
Oral medication related to gabapentin, shown effective for neuropathic pain after shingles.
Considerations: May cause dizziness, sleepiness, and leg or ankle swelling (edema).
Lidocaine 5% patch
Topical patch placed over the painful area; numbs sensitive skin locally.
Considerations: Especially useful for localized pain and touch sensitivity; little whole-body absorption.
Capsaicin 8% patch
High-strength patch applied in the clinic by a trained clinician.
Considerations: For selected patients with persistent localized nerve pain; temporary burning at the site is expected.
Tricyclic antidepressants (nortriptyline, amitriptyline)
Low-dose medications that change how pain signals are processed.
Considerations: Used in selected patients; may cause dry mouth, constipation, drowsiness, and heart-rhythm effects, especially in older adults.
Ordinary pain relievers such as acetaminophen or ibuprofen often provide limited relief for established nerve pain. Opioids are not recommended as routine first-line treatment. Many patients do best with a combination approach tailored to them — learn more in How Do You Treat Neuropathy?
Can Postherpetic Neuralgia Be Prevented?
The most effective step is Shingrix vaccination, which substantially reduces the risk of shingles and its complications, including PHN. It is generally recommended for adults age 50 and older and for certain immunocompromised adults age 19 and older.
If shingles does develop, prompt antiviral treatment — ideally within 72 hours of rash onset — can shorten the illness and reduce acute pain. Antivirals do not guarantee that PHN will be prevented, but early treatment is still important.
When Should You See a Neurologist?
- Pain persists after the shingles rash heals
- Burning or shooting pain disrupts your sleep
- Pain is not adequately controlled with initial treatment
- Medication side effects limit treatment
- Symptoms are atypical or the diagnosis is uncertain
- Weakness or other neurological symptoms develop
Shingles near the eye needs prompt care
A shingles rash on the forehead, around the eye, or on the tip of the nose can threaten vision. Seek prompt medical evaluation the same day.
Frequently asked questions
- Does postherpetic neuralgia ever go away?
- For many people, yes. Pain often gradually improves over weeks to months. Some people, particularly older adults or those who had a severe shingles episode, continue to have pain for a year or longer. Treatment aims to reduce pain and improve sleep and function while healing occurs.
- Can nerve pain last years after shingles?
- It can. A minority of people have pain that persists for years. Even long-standing pain can often be made more manageable with the right combination of topical and oral treatments.
- What is the best medication for postherpetic neuralgia?
- There is no single best medication for everyone. Gabapentin, pregabalin, and lidocaine 5% patches are common first options, with capsaicin 8% patches and tricyclic antidepressants used for selected patients. The choice depends on where the pain is, other medical conditions, kidney function, and side-effect risks.
- Does gabapentin help shingles nerve pain?
- Gabapentin can reduce postherpetic neuralgia pain in many patients. It is usually started at a low dose and increased gradually, and doses must be adjusted for kidney function. Dizziness and sleepiness are the most common side effects.
- Can shingles cause permanent nerve damage?
- Shingles can injure sensory nerves, and in some people the changes in pain signaling and skin sensation are long-lasting. Shingles can occasionally affect motor nerves and cause weakness, which needs medical evaluation.
- Is postherpetic neuralgia contagious?
- No. Postherpetic neuralgia is nerve pain, not an active infection, so it cannot be spread to others. An active shingles rash with open blisters, however, can spread the varicella-zoster virus to people who have never had chickenpox or the vaccine.
- Can you have postherpetic neuralgia without a rash?
- Postherpetic neuralgia follows a shingles episode, which usually includes a rash. Rarely, the virus reactivates and causes nerve pain without a visible rash, called zoster sine herpete. Because many conditions can cause localized nerve pain, this diagnosis requires careful medical evaluation.
- Should I see a neurologist for pain after shingles?
- Consider a neurologist if pain continues after the rash heals, disrupts sleep, is not controlled with initial treatment, if medication side effects limit treatment, if the diagnosis is uncertain, or if weakness or other neurological symptoms develop.
Persistent Nerve Pain After Shingles?
NeurologistCare provides neurological evaluation for neuropathy, nerve pain, and related neurological symptoms. For nonemergency appointments, call Illinois: 815-337-7100 or Wisconsin: 262-245-0535. Visits are available in person in Crystal Lake and Woodstock, Illinois, and Lake Geneva, Wisconsin, with telehealth for eligible patients in Illinois and Wisconsin when clinically appropriate.
Amarish Dave, DO
Board Certified Neurologist
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Medical disclaimer
The information on this website is educational and does not replace an individual medical evaluation. It does not diagnose any condition. If you believe you are experiencing a medical emergency, call 911.
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