How to Manage Shingles Pain

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Shingles (herpes zoster) is an infectious disease involving a painful, tingly, itchy rash with clusters of fluid-filled blisters called vesicles. The vesicles can appear anywhere on the body, but they usually appear on one side of the torso or near the ribs.

The rash usually heals within two to four weeks. But after shingles runs it course, the pain can resurface again and again (PHN).

Early treatment for shingles includes antiviral medications that can shorten the duration and lessen the severity of symptoms. It’s important to seek medical attention at the first sign of symptoms to help with shingles pain.

rash on stomach

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Pain During Shingles

Shingles pain may be experienced in the area where the blisters will soon surface (before any visible rash is present). A person often experiences a pins and needles sensation, or a painful, itchy feeling at this stage of the disease called the prodromal phase. The prodromal phase may last several days.

As the condition progresses, a painful red rash with blisters appears and new vesicles will continue forming for three to five days. The blisters will gradually burst, eventually crusting over, sometimes causing severe itchiness.

The herpes zoster virus begins to spread from the nerve root to the peripheral (outside of the central nervous system) nerve endings. This causes the nerves to send messages to the brain that are interpreted as severe pain, burning, or itching. The skin—located in the rash area—becomes much more sensitive than it normally is.

The type of pain that is common for people with shingles includes:

  • Stabbing or burning pain
  • Pain that feels like an electric shock
  • Pins and needles sensation
  • Burning or throbbing pain in the eye, blurred vision, extreme sensitivity to light

Shingles and Your Eyes

If the shingles rash breaks out on the face, near the eye, the vision may be affected. An ophthalmologist should be consulted right away when pain or other symptoms of shingles affect the eye or the area near the eye.

Shingles pain—and other symptoms from an outbreak of herpes zoster—usually lasts between three to five weeks. Most people experience shingles once, but in some instances, people will continue to experience pain. When this happens, it’s called postherpetic neuralgia (PHN).

Pain After Shingles

Approximately 10 to 18% of those who get shingles will experience PHN. The risk of PHN increases with age.

PHN involves pain and discomfort in the area where the shingles occurred. It’s not possible to predict who will develop the long-term symptoms of PHN, but age, race, and general health are thought to play a role in its development.

The pain from PHN is defined as mild to severe pain that continues months after the initial rash breaks out. Symptoms of discomfort from PHN may include:

  • Pain that is intermittent or constant
  • Pain that is easily stimulated by simply touching the skin (a condition called allodynia)
  • Tingling
  • Coldness
  • Loss of feeling

Scientists are unclear about the exact cause of the ongoing pain that occurs when a person has PHN. Some experts hypothesize that there is residual inflammation from damage to the nerve after the initial outbreak of shingles resolves.

Treatment

Treatment of Pain During Shingles

Pain management for shingles discomfort may include:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil or Motrin) or naproxen (Aleve or Naprosyn)
  • Tylenol (acetaminophen)
  • Antiviral medications
  • Corticosteroids
  • Narcotic pain relievers

Treatment of Pain After Shingles

Treatment for people with PHN may include:

  • Nerve blocks: Local anesthetic or alcohol injected directly into the nerve affected
  • Thoracic epidural injections: Local injection in the space around the spinal cord
  • Antidepressant medications: Such as amitriptyline
  • Membrane stabilizers: Such as gabapentin
  • Capsaicin application: Topical (on the skin) cream applied to the affected area

Prevention

For some people, pain after shingles can become resistant to treatment; this is why very early intervention is vital. Ideally, treatment should begin when a person initially feels the tingling or burning sensation, even before the rash breaks out.

Shingles Vaccine

A shingles vaccine is the only way to protect against shingles; it also guards against PHN.

The Centers for Disease Control and Prevention (CDC) recommends that any person aged 50 or older should have two doses of the Shingrix vaccine (each dosage is separated by two to six months). Shingrix is said to initially provide 90% effectiveness against shingles and PHN. Protection remains at more than 85% for four years after a person is vaccinated.

Coping With Shingles Pain

If you have shingles, you may be wondering how to cope with the pain:

  • Be sure to get plenty of sleep and eat a healthy diet to help boost your immune system.
  • Wear comfortable, loose clothing with natural fiber (such as cotton).
  • Establish or maintain a regular exercise routine.
  • Utilize home remedies to help soothe pain from blisters.
  • Engage in activities that help take your mind off of the pain.
  • Establish a routine to help manage stress.
  • Seek out support when needed from family and friends as well as professional supportive services.
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Article Sources
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  1. Centers for Disease Control and Prevention. Shingles (herpes zoster). Updated October 5, 2020.

  2. MedlinePlus. Postherpetic neuralgia. Updated April 2, 2021.

  3. National Institute of Neurological Disorders and Stroke. Shingles: hope through research. Updated March 22, 2020.

  4. MedlinePlus. Shingle-aftercare. Update May 4, 2021.

  5. Cleveland Clinic. Burning, lingering pain after shingles? 5 options may help you. Updated March 16, 2020.

  6. Cleveland Clinic. Shingles. Updated February 17, 2020.

  7. National Institute on Aging. Shingles. Updated February 1, 2021.