Post-Herpetic Neuralgia Treatment

Medically reviewed by Joshua L. Hare, DO, Founder & Medical Director

Nerve pain that outlasts shingles

Post-herpetic neuralgia is nerve pain that continues after a shingles rash has healed,[1] in the same band of skin the rash occupied. The shingles virus injures the nerve itself, which is why the pain can persist for months after the skin recovers. It is often burning, stabbing, or electric, sometimes with skin so sensitive that clothing is hard to tolerate. It most often affects one side of the chest or trunk and becomes more common with age. At IPC, treatment is matched to where the affected nerve runs: intercostal nerve blocks for chest-wall involvement, stellate ganglion blocks when the face or arm is affected, and epidural steroid injections for thoracic nerve roots.

Symptoms of post-herpetic neuralgia

Symptoms stay in that same strip of skin:

• Burning, stabbing or electric pain in the area where the rash was, most often a band on one side of the chest, trunk or face
• Skin so sensitive that light touch — clothing, bedsheets, a breeze — is painful
• Itching or numbness in the same band
• Pain still present three months or more after the rash healed
• Sleep and concentration disrupted by the pain

Post-herpetic neuralgia becomes more common with age, and the pain can fluctuate — better some weeks, worse others — without that meaning it is settling.

When to see a pain specialist about post-herpetic neuralgia

If nerve pain is still present once the rash has fully healed, it is reasonable to be evaluated rather than wait it out — persistent nerve pain does not reliably fade on its own. An evaluation identifies which nerve territory is involved.

A new shingles rash should be seen by a doctor promptly — antiviral treatment works best when started early — and a rash involving the eye or the tip of the nose needs same-day medical attention.

Treatment options for post-herpetic neuralgia

Which block is appropriate depends on the territory of the affected nerve; your physician will match the injection to where the rash was.

References

Clinical sources for this page.

1. Postherpetic Neuralgia. StatPearls [Internet], National Library of Medicine; updated April 17, 2023. Back to first citation ↑