Shingles (herpes zoster) is a viral infection that causes pain during an active outbreak and long after the itchy, red, blister-filled rash has healed—a condition known as postherpetic neuralgia.[1,2] It’s caused by the same virus that causes chickenpox: the varicella-zoster virus. [1]
Certain conditions—like cancer, HIV, transplants, stress, diabetes, or having a weakened immune system—can raise your chances of shingles showing up. While shingles can happen to anyone, your risk increases significantly if you’re over 50. [1]
The virus can stay hidden in your nervous system for years before suddenly reactivating, causing burning pain and an itchy rash. The good news? Whether you’re dealing with discomfort now or lingering pain that won’t let up, there are ways to manage it—from at-home care to advanced pain management treatments.
Managing Pain During an Active Shingles Outbreak
Everyone feels shingles pain a little differently, but it typically affects the nerves, creating sensations like burning, tingling, or sharp, stabbing discomfort. [3] Getting to your doctor right away is the first line of defense when treating shingles. They will begin treatment to shorten the duration of your outbreak, prevent possible complications, and ease your pain.
Start Antivirals ASAP
Early treatment with antiviral medications like acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex) is recommended to speed healing and lower the risk of nerve damage.[4]
Use Over-the-Counter Pain Relief & Skin Soothers
OTC medications like acetaminophen (Tylenol) or ibuprofen (Advil) can ease mild to moderate pain sensations.[4] Your doctor may prescribe pain-relieving topical creams, gels, or sprays, or a course of steroids.[4]. Capsaicin patches (Qutenza) provide soothing pain relief for shingles outbreaks and post-outbreak symptoms.[3]
At home, you can try cold compresses, cool showers or baths, calamine lotion, and oatmeal baths to ease the pain and calm the itchiness.[3] There is no cure for the discomfort associated with shingles rashes, but you may find relief through natural healing treatments, such as homeopathic remedies and dietary adjustments.
When Shingles Pain Is Severe
A small percentage of people may experience excruciating shingles flare-ups and need more intervention than antivirals and at-home care. Your doctor may prescribe stronger pain medications and steroid injections to help reduce pain and inflammation. Nerve blocks given by pain management specialists may also offer relief while you heal.
When the Rash Is Gone but Pain Remains
Postherpetic Neuralgia (PHN) is the lingering pain after your shingles heal. It can last for months or even longer and feel like sharp, burning, or shooting pain that conventional care doesn’t relieve. Your physician may treat your PHN pain with one or more of the following treatments:
- Anticonvulsants like gabapentin or pregabalin [4]
- Tricyclic antidepressants (like amitriptyline) [4]
- Topical lidocaine or capsaicin cream [5]
- Capsaicin patches (Qutenza) [4]
- Membrane stabilizers (like gabapentin) [5]
- Prescription painkillers (including opioids) [6]
- Anticonvulsants [7]
Pain Management Procedures That Can Help
These procedures are done at a pain clinic by trained specialists who can create a treatment plan ideal for you that targets your pain rather than treats the whole body systemically, like pain medication.
For persistent, tough-to-treat PHN or severe shingles pain, a pain specialist may recommend:
- Stellate ganglion block [8]
- Peripheral nerve stimulation [8]
- Spinal cord stimulation [8]
- Paravertebral block [8]
- Radiofrequency ablation [8]
- TENS (transcutaneous electrical nerve stimulation) [8]
- Intercostal nerve blocks [5]
- Thoracic epidural injections [5]
Lifestyle Tips for Shingles Outbreaks
To help you cope with your shingles, here are some tips you can start right away:
- Wear loose clothing to avoid irritating the rash.
- Stay active with gentle movements, such as walking.
- Keep stress low—it can trigger or worsen outbreaks.
- Good sleep, hydration, and healthy nutrition support healing.
Shingles Pain Relief That’s Right for You
Shingles pain—whether it strikes during an outbreak or persists long after—can seriously affect your day-to-day life. The good news is that relief is possible. From home care to advanced treatments like nerve blocks or spinal cord stimulation, a pain management clinic can help you take control. Although it’s not a cure for existing pain, the Shingrix vaccine can help prevent future outbreaks and reduce the risk of long-term nerve pain.[9]
If you’re struggling with a painful shingles rash or postherpetic neuralgia, don’t wait—reach out and get the care you need to feel better.
Resources:
- Shingles – Symptoms and causes. Mayo Clinic [Internet]. Published August 20, 2022. Accessed April 23, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054
- Postherpetic neuralgia – Symptoms and causes. Mayo Clinic [Internet]. Published 2025. Accessed April 23, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588
- Veazey K. Shingles Pain: What It Feels Like, How to Treat It, and FAQs. Healthline [Internet]. Published February 8, 2023. Accessed April 23, 2025. Available from: https://www.healthline.com/health/shingles-pain
- Shingles – Diagnosis and treatment – Mayo Clinic [Internet]. Published 2018. Accessed April 23, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/shingles/diagnosis-treatment/drc-20353060
- Burning, Lingering Pain After Shingles? 5 Options May Help You. Cleveland Clinic [Internet]. Published March 16, 2020. Accessed April 23, 2025. Available from: https://health.clevelandclinic.org/when-your-shingles-pain-lingers-5-options-may-help
- Postherpetic Neuralgia: Nerve Pain After Shingles. WebMD [Internet]=. Accessed April 23, 2025. Available from: https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-postherpetic-neuralgia-treatment
- Postherpetic neuralgia – Diagnosis and treatment. Mayo Clinic [Internet]. Published 2018. Accessed April 23, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593
- Lin CS, Lin YC, Lao HC, Chen CC. Interventional Treatments for Postherpetic Neuralgia: A Systematic Review. Pain Physician [Internet]. 2019;22(3):209-228. Accessed April 23, 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/31151330/
- Shingles vaccine: Should I get it? Mayo Clinic [Internet]. Accessed April 23, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/shingles/expert-answers/shingles-vaccine/faq-20057859
