Postherpetic neuralgia is pain that continues longer than a month after a bout of shingles. This pain may last from months to years.

Shingles is a painful, blistering skin rash that is caused by the varicella-zoster virus. This is the same virus that causes chickenpox. Shingles is also called herpes zoster.

Herpes zoster - postherpetic neuralgia; Varicella-zoster - postherpetic neuralgia; Shingles - pain; PHN

Postherpetic neuralgia can:

• Limit your everyday activities and make it hard to work.
• Affect how involved you are with friends and family.
• Cause feelings of frustration, resentment, and stress. These feelings may make your pain worse.

Even though there is no cure for postherpetic neuralgia, there are ways to treat your pain and discomfort.

You can take a type of medicine called nonsteroidal anti-inflammatory drugs (NSAIDs). You do not need a prescription for some of these.

• Two kinds of NSAIDs are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your health care provider before using these medicines.

You may also take acetaminophen (such as Tylenol) for pain relief. If you have liver disease, talk with your provider before using it.

Your provider may prescribe a narcotic pain reliever. You may be advised to take them:

• Only when you have pain
• On a regular schedule, if your pain is hard to control

A narcotic pain reliever can:

• Make you feel sleepy and confused. Do not drink alcohol or use heavy machinery while you are taking it.
• Make your skin feel itchy.
• Make you constipated (unable to have a bowel movement easily). Try to drink more fluids, eat high-fiber foods, or use stool softeners.
• Cause nausea, or make you feel sick to your stomach. Taking the medicine with food may help.

Your provider may recommend skin patches that contain lidocaine (a numbing medicine). Some are prescribed and some you can buy on your own at the pharmacy. These may relieve some of your pain for a short time. Lidocaine also comes as a cream that can be applied to areas where a patch is not easily applied.

Zostrix, a cream that contains capsaicin (an extract of pepper), may also reduce your pain.

Two other types of prescription medicines may help reduce your pain:

• Anti-seizure medicines, such as gabapentin and pregabalin, are used most often.
• Medicines to treat pain and depression, most often ones called tricyclics, such as amitriptyline or nortriptyline.

You must take the medicines every day. They may take several weeks before they begin to help. Both of these types of medicines have side effects. If you have uncomfortable side effects, do not stop taking your medicine without talking with your provider first. Your provider may change your dosage or prescribe a different medicine.

Sometimes, a nerve block can be used to temporarily reduce pain. Your provider will tell you if this is right for you.

Many non-medical techniques can help you relax and reduce the stress of chronic pain, such as:

• Meditation
• Deep-breathing exercises
• Biofeedback
• Self-hypnosis
• Muscle-relaxing techniques
• Acupuncture

A common type of talk therapy for people with chronic pain is called cognitive behavioral therapy. It may help you learn how to cope with and manage your responses to pain.

Contact your provider if:

• Your pain is not well-managed
• You think you may be depressed or are having a hard time controlling your emotions

Cohen J. Varicella-zoster virus (chickenpox, shingles). In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 346.

Dinulos JGH. Warts, herpes simplex, and other viral infections. In: Dinulos JGH. Habif's Clinical Dermatology: A Color Guide in Diagnosis and Therapy. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 12.

Whitley RJ. Chickenpox and herpes zoster (varicella-zoster virus). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 136.