Shingles can cause significant pain during the active infection, but for some people the discomfort continues even after the rash has healed. Persistent nerve pain following shingles is known as postherpetic neuralgia.
Postherpetic neuralgia can cause burning, aching, stabbing or highly sensitive skin in the area previously affected by shingles. For some people the symptoms gradually improve over a few months, while for others the pain can continue for much longer and interfere with sleep, mobility, work and everyday activities.
This guide explains why nerve pain can continue after shingles, the symptoms associated with postherpetic neuralgia, how the condition is assessed and the treatment options that may be considered.
Please note: this article provides general information and should not replace assessment or advice from your GP or specialist. Seek medical advice if you have persistent pain after shingles, particularly if it is severe or affecting your daily life.
What Is Postherpetic Neuralgia?
Postherpetic neuralgia is long-lasting nerve pain that develops in an area of the body previously affected by shingles.
Shingles is caused by reactivation of the varicella-zoster virus, the same virus that causes chickenpox. After a person has chickenpox, the virus remains inactive within the nervous system and can reactivate later in life.
During shingles, the virus can affect nerves as well as the surrounding skin. In some people, this nerve irritation or damage continues to produce pain after the shingles rash has disappeared.
The NHS describes post-herpetic neuralgia as long-lasting pain following shingles and notes that symptoms usually occur in the same area as the original rash. NHS guidance on post-herpetic neuralgia provides further information.
Why Can Shingles Cause Lasting Nerve Pain?
Shingles affects sensory nerves that carry information such as touch, temperature and pain between the skin and the nervous system.
When these nerves are affected by the shingles virus, normal pain signalling can become disrupted. The affected nerves may continue sending pain signals even after the skin itself has healed.
This can result in neuropathic pain, which behaves differently from pain caused by an ordinary muscle strain, joint injury or inflammation.
Neuropathic pain may therefore require a different treatment approach from common musculoskeletal pain.
What Does Postherpetic Neuralgia Feel Like?
The symptoms can vary considerably between individuals.
Common symptoms may include:
- burning pain;
- aching or throbbing pain;
- sharp or stabbing pain;
- shooting or electric shock-like sensations;
- increased sensitivity of the skin;
- pain caused by light touch or pressure;
- pain triggered by clothing touching the skin;
- itching;
- numbness or reduced sensation; and
- increased sensitivity to changes in temperature.
One particularly difficult symptom is allodynia, where something that would not normally be painful, such as clothing or light touch, produces significant discomfort.
The NHS notes that postherpetic neuralgia may cause aching, burning or sharp pain as well as extreme sensitivity to touch or temperature changes.
Where Does Postherpetic Neuralgia Occur?
The pain usually occurs in the same part of the body where the shingles rash appeared.
Shingles commonly affects one side of the chest or abdomen, although it can occur elsewhere on the body.
Some people experience persistent pain around the ribs, chest or upper abdomen after the visible rash has disappeared.
If you are experiencing this type of discomfort, you may also find our guide on whether shingles can cause chest pain useful.
Chest pain should not automatically be assumed to be caused by shingles. New, severe or unexplained chest pain requires appropriate medical assessment because there are many other possible causes.
How Long Does Nerve Pain Last After Shingles?
There is no single duration for postherpetic neuralgia.
For some patients, symptoms gradually improve over several weeks or months. For others, the pain may continue for more than a year.
The NHS states that postherpetic neuralgia usually improves gradually, although the time required can vary from several months to more than a year.
The severity of the pain may also change over time. Some patients experience constant pain, while others have intermittent episodes triggered by touch, temperature or movement.
Who Is More Likely to Develop Postherpetic Neuralgia?
Not everyone who develops shingles will experience persistent nerve pain afterwards.
The risk tends to be greater in older people and may also be higher when the original shingles episode was severe or affected a large area of the body.
The NHS also identifies conditions affecting the immune system and conditions such as diabetes among factors associated with a greater risk of postherpetic neuralgia.
However, persistent nerve pain can occur in people without obvious risk factors, which is why ongoing symptoms should be assessed individually.
When Should You See a Doctor After Shingles?
You should speak to your GP if pain continues in the area affected by shingles and is not improving.
Medical assessment becomes particularly important if:
- the pain is severe;
- the pain is preventing you from sleeping;
- your normal activities are becoming difficult;
- your symptoms are worsening rather than improving;
- ordinary pain relief is not helping;
- you experience marked numbness or sensitivity;
- the diagnosis is uncertain; or
- your symptoms have persisted for a significant period after the rash healed.
The NHS recommends seeing a GP when pain continues in an area previously affected by shingles.
How Is Postherpetic Neuralgia Diagnosed?
Postherpetic neuralgia can often be recognised from the history of shingles and the pattern of persistent nerve pain in the same part of the body.
A clinician may ask about:
- when the shingles episode occurred;
- where the original rash appeared;
- how long the pain has continued;
- the type of pain you experience;
- whether light touch causes pain;
- sleep disturbance;
- medicines already tried; and
- how the symptoms affect everyday activities.
A physical examination may also be performed to assess sensation and tenderness and to consider whether another condition could be responsible for the symptoms.
Treatment Options for Postherpetic Neuralgia
Postherpetic neuralgia can sometimes be difficult to treat, and there is no single treatment that works for everyone.
Treatment is usually aimed at reducing pain, improving sleep and function, and helping patients manage persistent nerve symptoms while the condition gradually improves.
The treatment plan should take account of the severity of symptoms, other medical conditions, current medication, potential side effects and how significantly the pain is affecting everyday life.
Medicines for Nerve Pain
Neuropathic pain often responds differently to ordinary painkillers.
Depending on the individual patient, clinicians may consider medicines specifically used for nerve pain.
The NHS lists medicines such as amitriptyline, duloxetine, gabapentin and pregabalin among medicines that may be prescribed for nerve pain in postherpetic neuralgia.
These medicines are prescription treatments and should only be taken under appropriate medical supervision. They can have side effects and are usually introduced and adjusted according to the patient’s response.
Topical Treatments
For some patients, treatment applied directly to the painful area may be considered.
For example, lidocaine-containing plasters may sometimes be used when other medicines are unsuitable or where symptoms are relatively localised.
The suitability of topical treatment depends on the patient’s symptoms and medical circumstances.
Pain Management Support
When persistent nerve pain becomes difficult to control, referral to a specialist pain service may be considered.
A specialist assessment allows the pain pattern, previous treatment and effect on daily life to be reviewed in more detail.
If you are unsure whether specialist assessment may be appropriate, see our guide on when to see a private pain management specialist.
Can Nerve Blocks Help Post-Shingles Nerve Pain?
Nerve blocks are procedures in which medication is delivered close to a nerve or group of nerves involved in transmitting pain.
They are used in the management of certain pain conditions, but they are not suitable for every patient with postherpetic neuralgia.
Whether an injection-based treatment should be considered depends on factors including the location and severity of the pain, previous treatments, the patient’s overall health and the specialist’s clinical assessment.
You can learn more about how these procedures are used in our guide to nerve block injections for pain.
Can Postherpetic Neuralgia Affect Sleep and Daily Life?
Persistent neuropathic pain can have effects beyond the painful area itself.
Patients may find that pain interferes with:
- sleep;
- concentration;
- work;
- exercise;
- wearing certain clothing;
- social activities; and
- general wellbeing.
For some people even contact with bedding or clothing can be uncomfortable because the affected skin has become extremely sensitive.
This is one reason specialist pain management often considers the wider effect of pain rather than focusing only on a numerical pain score.
Things That May Help at Home
Simple measures may help some people manage sensitive skin while medical treatment is being reviewed.
NHS advice includes wearing loose-fitting cotton or silk clothing, protecting particularly sensitive skin and using cool measures such as cool showers or appropriately wrapped cold packs.
Keeping a pain diary can also be useful. Recording pain severity, triggers, sleep, medication and activities may help patients and clinicians identify patterns and assess whether treatment is helping.
Avoid applying extreme heat or cold directly to skin with reduced sensation, as nerve damage may make it harder to recognise injury.
Can Postherpetic Neuralgia Be Prevented?
It is not always possible to prevent postherpetic neuralgia, but reducing the risk of shingles and obtaining appropriate treatment when shingles develops can help.
The NHS advises that treatment for shingles works best when started promptly and notes that shingles vaccination reduces the risk of both shingles and postherpetic neuralgia.
Anyone who develops a new shingles rash should seek appropriate medical advice, particularly if they are at increased risk of complications.
When Should You See a Pain Specialist?
Many cases can initially be managed through primary care. However, specialist pain assessment may be considered when symptoms are severe, persistent or have not responded adequately to initial treatment.
The NHS notes that patients may be referred to a specialist pain clinic when severe pain affects daily activities or when treatments prescribed in primary care have not provided adequate relief.
A specialist consultation can review:
- the nature of the nerve pain;
- treatments already attempted;
- medication effectiveness and side effects;
- sleep and functional problems;
- whether additional investigations are required; and
- whether other pain-management approaches may be appropriate.
At Pain Consultants, patients with persistent neuropathic pain can be assessed individually to determine the most appropriate treatment pathway.
Frequently Asked Questions About Postherpetic Neuralgia
Can shingles nerve pain become permanent?
Postherpetic neuralgia often improves gradually, but the duration varies considerably. Some people recover within months while others experience symptoms for more than a year. Persistent or severe pain should be reviewed by a healthcare professional.
Why does my skin still hurt after the shingles rash has gone?
Shingles can affect the nerves supplying the area of skin where the rash occurred. These nerves may continue to produce abnormal pain signals after the visible rash has healed, resulting in postherpetic neuralgia.
What does postherpetic neuralgia feel like?
Patients may describe burning, aching, stabbing, shooting or electric shock-like pain. The skin can also become extremely sensitive, meaning even light touch or clothing may cause pain.
How long does postherpetic neuralgia last?
The duration varies. It may improve over several months, although symptoms can sometimes last for more than a year.
Can postherpetic neuralgia get worse?
Symptoms can fluctuate. If pain is becoming progressively worse, new symptoms develop or the diagnosis is uncertain, medical assessment is important to exclude other causes.
Can nerve blocks be used for postherpetic neuralgia?
Injection-based pain treatments may be considered in selected cases following specialist assessment, but nerve blocks are not appropriate for every patient. Treatment should be individualised according to the patient’s symptoms and medical history.
Is postherpetic neuralgia the same as shingles?
No. Shingles is the active viral condition that typically causes a painful rash. Postherpetic neuralgia is persistent nerve pain that can remain after the shingles rash has healed.
When should I see a pain specialist?
Specialist assessment may be appropriate when pain is severe, persists despite treatment, interferes significantly with sleep or daily activities, or requires a more detailed pain-management plan.
Speak to Pain Consultants About Persistent Nerve Pain
Persistent nerve pain after shingles can be difficult to live with, particularly when sensitive skin, burning pain or disturbed sleep continues after the visible rash has disappeared.
Although postherpetic neuralgia often improves over time, patients with severe or persistent symptoms may benefit from specialist assessment to review the diagnosis, treatments already tried and the available pain-management options.
If nerve pain after shingles is affecting your daily life, book a consultation with Pain Consultants for an individual specialist assessment.