What if Pain Persists Even After a Shingles Rash Clears Up?

A fellow caregiver asked...

What does it mean if pain persists even after a shingles rash clears up?

Expert Answer

Dr. Leslie Kernisan is the author of a popular blog and podcast at BetterHealthWhileAging.net. She is also a clinical instructor in the University of California, San Francisco, Division of Geriatrics.

It's common for pain to continue for several weeks after the telltale rash and blisters of shingles have cleared. When pain is still present more than four months later, this is called postherpetic neuralgia (PHN). This condition causes the pain of shingles to last for weeks or months, sometimes years. At this point, there's no rash, only shooting or tingling pain in a particular area. Some people are also sensitive to touch (even the feel of a sheet on the skin) or to light.

PHN is a common complication of shingles -- about 5 to 7 percent of adults under age 60 develop it, and the risk rises with age to about 15 to 20 percent of those over age 80.

To reduce the odds of developing PHN after shingles:

  • Get vaccinated for shingles (before it happens). Not only does vaccination make you less likely to get shingles in the first place, but if you do get shingles, you're much less likely to get PHN afterward.
  • Get treated with antivirals within three days of developing the shingles rash.

The nerve pain from shingles and PHN can be severe, and often the doctor will need to prescribe strong pain medications. These may include capsaicin cream, a patch that delivers lidocaine, or strong oral pain medicines such as opiates. Some drugs used for depression or seizures are also good at treating PHN, but these can be tricky for older adults -- some of these medicines can cause falls or confusion in a vulnerable elder.