Postherpetic Neuralgia (PHN): What It Is and How to Handle It
Postherpetic neuralgia is nerve pain that stays after a shingles rash heals. If you had shingles and the pain lingers for weeks or months, that pain is likely PHN. It can be burning, stabbing, or like electric shocks. Light touch or clothes can feel painful. PHN can be intense and tiring, but there are clear steps that help most people.
Treatment options
Doctors usually start with medicines that calm nerve pain rather than typical painkillers. First choices include gabapentin or pregabalin—these reduce nerve signals and work for many patients. Antidepressants such as amitriptyline or nortriptyline can also help by changing how your brain senses pain. Topical options are useful when pain is in one area: lidocaine patches and high‑concentration capsaicin patches can lower local sensitivity.
Sometimes a short trial of an opioid or tramadol is used for severe flareups, but these are not ideal long‑term. Your doctor may suggest nerve blocks or injections for persistent, focal pain. In rare cases, referral to a pain clinic for advanced treatments like neuromodulation is appropriate.
Self-care and prevention
Simple daily habits make a big difference. Keep skin clean and moisturized after shingles. Wear loose clothing and avoid tight bands over painful areas. Heat pads or cold packs applied for 15–20 minutes can reduce spikes of pain. Rest, steady sleep, and gentle walking help your nerves recover. Low‑impact activities like walking and stretching reduce stress and improve mood, which makes pain easier to manage.
Prevention matters: the shingles vaccine (Shingrix) sharply lowers the chance of getting shingles and greatly cuts the risk of PHN. Clinical trials showed vaccines reduce PHN risk by about 90% in older adults. If you’re eligible, talk to your doctor about getting vaccinated.
When to see your doctor: if pain is severe, stops you from sleeping, or limits daily tasks, get help. Also see a clinician if numbness, weakness, fever, or spreading rash appears—these can signal complications. Bring a pain diary to appointments: note pain level, what triggers it, and what eases it. This helps your provider choose the best treatment fast.
Medication safety: tell your doctor about other drugs and conditions—some nerve meds cause dizziness or interact with heart or blood pressure drugs. Start low and go slow with doses; report side effects early so adjustments can be made.
Ask these quick questions at your appointment: How long before I feel relief? Which side effects are most likely? Can I combine a topical with a pill? Are any tests or blood checks needed? Also ask about non-drug options like cognitive behavioral therapy for chronic pain, physical therapy for stiffness, or local injections. Clear answers make follow-up. Bring a list of current medicines.
Living with PHN is tough, but many people improve with the right mix of medicine, self‑care, and support. If one approach doesn’t help, ask for a second opinion or a referral to a pain specialist. You don’t have to accept constant pain—options exist to help you get back to normal life.
