Learning About Postherpetic Neuralgia (PHN)

Postherpetic neuralgia (PHN) is nerve pain that can happen after you've had shingles. Shingles is a rash caused by the same virus that causes chickenpox. Shingles can attack the nerves under the skin, causing irritation and damage. In some people, the nerves don't heal at the same time as the rash. They keep sending pain signals, even after the skin has healed.

Most people heal from the shingles rash with no problem. But some people keep having pain after the rash goes away. It doesn’t mean that shingles has come back. Treatment can help reduce the pain. And for many people, the pain will go away over time.

Unlike the shingles rash, PHN can’t be spread to other people.

PHN is more common in people who are age 50 and older and people who have a weak immune system. It is also more common in people who had severe shingles pain, had a severe shingles rash, or didn't have antiviral treatment during shingles.

PHN may feel different from person to person. You may have pain that burns, that is sharp or stabbing, or that feels like an electric shock. You may also have tingling or numbness, itching, or pain from light touch (even from clothing).

The pain is usually in the same place that the shingles rash was. The symptoms may come and go or be constant. The pain can last a few weeks or months. Sometimes it can last years.

Your doctor will ask about your symptoms and your history of a shingles rash. They may do a physical exam.

Treatment for PHN includes medicines and self-care.

Over-the-counter pain medicine, such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol), may help reduce pain. But if they don't help enough, you may need medicines that calm the nerves that are sending pain signals. They include:

• Gabapentin or pregabalin.
• Tricyclic antidepressant medicines.
• Lidocaine patches or gel (numbing medicine).
• Capsaicin cream (warming medicine).

In addition to medicines, there are other ways to help soothe your pain. They include:

• Wearing soft clothing.
• Using cool packs.
• Gently moving and stretching.
• Doing relaxation and deep breathing exercises.
• Getting enough sleep.

If your pain is hard to manage, you may need to see a pain specialist. They may prescribe other types of pain treatment, such as a nerve block injection. You may be referred to a physical therapist. They can help you lower the sensitivity of the nerves causing you pain.

If you get shingles, starting antiviral medicine early can help prevent PHN.

You can lower your risk of shingles and PHN by having the shingles vaccine. Talk with your doctor if you haven’t had the vaccine yet.