Pain that lingers long after the shingles rash is gone.
Postherpetic neuralgia is the nerve pain that persists after a shingles outbreak — sometimes for months or years. The rash heals, but the damaged nerves keep sending pain signals. It can be one of the most difficult chronic pain conditions to live with, but there are effective treatments, and most people find meaningful relief.
Your doctor may call this postherpetic neuralgia or PHN.
Often seen within a few days — sometimes as soon as tomorrowRequest your first visit
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What shingles pain (postherpetic neuralgia) really is.
Shingles is caused by varicella-zoster — the same virus that causes chickenpox. After chickenpox resolves, the virus lies dormant in nerve tissue. Decades later, it can reactivate as shingles: a painful, blistering rash that follows the path of a specific nerve. The rash typically clears in two to four weeks. In some people, however, the nerve damage left behind keeps firing pain signals long after the skin has healed — that's postherpetic neuralgia.
PHN is most common in people over 60 and in those who had severe shingles or delayed treatment. The pain concentrates in the area where the rash appeared — often the trunk, one side of the chest, or the face. It can be constant or come in waves, and even light contact with clothing or a breeze over the skin can trigger intense pain.
The good news
Postherpetic neuralgia does improve over time for most people, especially with active treatment. The pain rarely stays at its worst indefinitely. Effective medications, patches, and interventional treatments can reduce pain substantially, improve sleep, and let you get back to normal activities while the nerves heal. Starting treatment early gives the best outcomes.
Allodynia and the dermatome distribution
PHN pain follows a dermatomal distribution — the anatomical zone supplied by the nerve the virus traveled along. A hallmark is allodynia: pain triggered by stimuli that shouldn't hurt, like light clothing contact. We assess allodynia severity, the extent of sensory loss in the affected dermatome, and any autonomic features, since these factors influence medication selection and whether interventional approaches like intercostal nerve blocks or spinal cord stimulation are appropriate.
Common signs we treat.
Burning pain where shingles appeared
A deep, persistent burning in the skin of the affected area — the most common complaint, often present around the clock.
Sensitivity to light touch
Allodynia — even gentle contact like clothing, a bedsheet, or a breeze can produce intense pain in the affected skin.
Stabbing nerve pain
Sudden, shooting or electric-shock pain that arrives without warning — superimposed on the constant background burning.
From hurting to healed.
We work from the least-invasive options upward, escalating only if you need it. Most patients improve well before surgery is ever discussed.
Diagnose the cause
A physician examines you and, if needed, reviews imaging to pinpoint exactly what's driving the pain.
Calm it down
Targeted physical therapy, activity guidance, and medication to settle the irritation and reduce inflammation.
Image-guided injections
If pain persists, a precisely targeted injection delivered to the source under imaging.
Advanced options
For the few who need more, minimally invasive interventional procedures — with surgery as a last resort.
Treatment is matched to your specific diagnosis at your visit. The options shown reflect NASPAC's general approach and should be confirmed against the practice's verified procedure list.
Still have questions?
When the varicella-zoster virus reactivates as shingles, it travels along a nerve and inflames it. In some people — particularly older adults or those with severe outbreaks — that inflammation leaves lasting nerve damage. The damaged nerve fibers continue to misfire, sending pain signals to the brain even after the skin has healed and the viral load is gone.
It varies widely. For some people, PHN resolves within a few months; for others, pain persists for a year or more. Age and the severity of the initial shingles outbreak are the strongest predictors. Untreated or undertreated PHN tends to last longer — which is why early, active pain management matters both for quality of life now and for the long-term prognosis.
First-line treatments include medications that calm nerve pain — certain antidepressants, anticonvulsants, and topical agents like lidocaine patches or capsaicin. These are often used in combination. For patients with severe or refractory PHN, interventional options including intercostal nerve blocks, epidural injections, and spinal cord stimulation can provide significant additional relief. We tailor the plan to your pain pattern and what you've already tried.
The shingles vaccine (Shingrix) substantially reduces the risk of developing shingles in the first place, and if shingles does occur in vaccinated individuals, it tends to be less severe — which lowers the risk of PHN. For people who develop shingles, starting antiviral medication within 72 hours of rash onset reduces both severity and the likelihood of PHN. If you or a family member has had shingles, talk to your physician about vaccination.
Stop living with the nerve pain.
Book with a board-certified pain physician near you — most patients are seen within days.
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