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Pain after shingles (postherpetic neuralgia)

Mamae i muri i te mate koroputa

Some people who've had shingles go on to have pain that lasts for months or years after the rash has gone. The medical term for this is postherpetic neuralgia.

We don't completely understand why some people get ongoing pain after shingles. We know that shingles causes nerve inflammation and that you can expect pain while you have the shingles rash. It's possible that postherpetic neuralgia may be related to the scar tissue next to the nerve or in the nearby part of the spinal cord that may cause pain messages to be sent to your brain.

You have a higher risk of getting postherpetic neuralgia if you:

Symptoms of postherpetic neuralgia

Treating postherpetic neuralgia

Postherpetic neuralgia is a type of nerve pain or neuropathic pain, so normal pain relief like paracetamol and ibuprofen aren't likely to be helpful. Other medicines may not stop the pain completely, but they can reduce it. You may need to try several types of medicine to find one, or a combination that works best for you. The following medications have been found to be helpful:

Capsaicin cream

Capsaicin cream is rubbed onto the painful area of your skin three to four times a day. You should only apply it to healed skin, not on blisters as it can cause a painful burning feeling. Capsaicin is thought to work by blocking nerves from sending pain messages.

Antidepressants and gabapentinoids

Some medicines used to treat depression also work for nerve pain, so you may be advised to try these. They include amitriptyline and nortriptyline.

Another class of medicines, gabapentinoids (which include gabapentin and pregabalin) have been found to be helpful in relieving nerve pain. These usually ease the pain within a few days. But it may take two to three weeks to ease, and it can take several weeks before you have the full benefit. Some people give up on their treatment too early. It's best to continue for at least four to six weeks to see how well the medication is working.

If the medication works, it's usual to take it for a further month after the pain has gone or eased. After that, the dose is gradually reduced, then stopped.

Self-care for postherpetic neuralgia

Living with postherpetic neuralgia can be very difficult because it can affect your ability to carry out simple daily activities, such as dressing and bathing. It can also lead to further problems, including extreme tiredness, sleeping difficulties and depression. Speak to your general practice team if you need support in any of those areas.

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See also:

Chronic (persistent) pain

Content shared between HealthInfo Canterbury, KidsHealth and Health Navigator NZ as part of a National Health Content Hub collaborative. Page created October 2022.

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Review key: HIPHN-19404