Postherpetic Neuralgia Overview: Risk Factors, Treatment and Prevention

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Postherpetic neuralgia is a condition where the pain experienced with shingles does not go away even after the rash has healed.  Topical agents, antidepressants, and opioids are a few of the pain management treatment options that may be considered for postherpetic neuralgia. The CDC recommends vaccinating for shingles to help prevent risk of postherpetic neuralgia. 

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You have probably seen commercials on your television about the Shingles virus and how painful the rash that shingles causes can be. 

But did you know that once the shingles rash goes away, the pain individuals experience can still stick around? 

Sometimes for years! YIKES! 

Read on to learn more about the chronic condition called postherpetic neuralgia (PNH), and what you can do to prevent this painful complication of shingles. 

What is Postherpetic Neuralgia?

Postherpetic neuralgia is a painful, chronic condition, affecting the nerves and skin. It is the most common complication of herpes zoster infection (a.k.a. shingles). Shingles results from reactivation of varicella-zoster, which is the virus that causes chickenpox. 

Shingles (Herpes Zoster) Rash I Photo Credit:

Postherpetic neuralgia is a condition that occurs when a person’s nerves are damaged, and the pain associated with shingles does not go away after the rash has healed.  When our nerves are damaged, they can’t communicate clearly and send messages from the skin to the brain, resulting in ongoing severe pain.

Symptoms of Postherpetic Neuralgia

Shingles typically causes a painful, blistering rash, and the symptoms of postherpetic neuralgia generally occur in the area of skin where the shingles outbreak first occurred.  Common symptoms include:

  • Pain lasting three months or longer: occurs after the shingles rash has healed and can be described as burning, sharp, or aching.
  • Sensitivity to touch: individuals cannot even bear the touch of clothing on the affected skin.
  • Itching and numbness: are less common, but can still occur with postherpetic neuralgia.

Risk Factors of Postherpetic Neuralgia

Your risk for developing PNH after having shingles increases with age.  About 10-13% of people age 60 and above who have shingles will develop PNH.  It is rare to see PNH in someone under the age of 40. 

Two other risk factors include the level of pain and the size of the rash – the more severe the pain and the larger the rash increases your chances of developing PNH.

Treatment of Postherpetic Neuralgia

The goal of treatment for PNH is to control and reduce pain until the condition goes away. One article summarized the pain management options in the following table:

Drug Class



Topical agents

Lidocaine and capsaicin work right on the skin, where you need

capsaicin can cause a burning sensation on the skin; usually resolves with repeated use

Antidepressants: Tricyclic antidepressant (TCA)

Best for pain relief. May help with sleep disturbance

Drowsiness, weight gain, and risk of abnormal heart rhythm

Selective serotonin and norepinephrine reuptake inhibitor (SNRI)

Helps with pain relief

Less effective than TCAs; cause nausea and dizziness


Gabapentin and pregabalin have fewer side effects

Dizziness, sleepiness, weight gain, and swelling


Fewest heart side effects.  May help with sleep.

Sedation, constipation, and risk of abuse

Typically, no one intervention reliably relieves the pain associated with PNH and effective treatment may require multiple drugs.

Prevention of Postherpetic Neuralgia

The only effective way to prevent PNH is to be protected from shingles infection. 

Two vaccines are licensed and recommended to prevent shingles in the United States:

  • Zoster vaccine live (Zostavax)
  • Recombinant zoster vaccine (Shingrix)   

Currently, the Centers for Disease Control and Prevention (CDC) recommends Shingrix as the preferred vaccine, over Zostavax, for healthy adults 50 years of age and older.

As of July 1, 2020, Zostavax will no longer be sold in the United States, but some pharmacies may still have it in stock after that date.  The CDC states that this vaccine is still safe and may be used until the supply expires which would be expected before or by November 18, 2020.

Current CDC guidelines recommend two doses of the Shingrix vaccine within six months. 

Talk to your pharmacist or healthcare provider to learn more about vaccination for shingles and decrease your risk of PNH. 


Shingles is a condition associated with a painful, blistering rash.  When the rash has healed, but the pain remains, it is a condition known as PNH.  Your risk of developing PNH increases with age.  

There are several options to help with pain management; you will need to be seen by your primary care provider to determine which is the most appropriate for you

The shingles vaccine is recommended for all patients 50 years of age and older. To learn more, please consult your pharmacist or primary healthcare provider.  


Chickenpox Vaccination: What Everyone Should Know. Centers for Disease Control and Prevention website. Reviewed August 7, 2019. Accessed August 26, 2020.

Shingles (Herpes Zoster). Centers for Disease Control and Prevention website. Reviewed June 26, 2019. Access August 26, 2020.

Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61(8):2437-2448.

Postherpetic Neuralgia. Mayo Clinic website.,herpes%20zoster)%20virus%20causes%20shingles. Accessed August 26, 2020.

Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84(3):274-280. doi:10.1016/S0025-6196(11)61146-4.

What Everyone Should Know About the Shingles Vaccine. Centers for Disease Control and Prevention website. Reviewed May 31, 2018. Accessed August 26, 2020.

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