He has waves of pain that start along the foot-long scar across his back and then shoot through his chest. The pain hits him at night when he’s trying to sleep, when he’s outdoors in the heat, or just randomly while he’s watching TV.
My 75-year-old dad delayed getting a shingles vaccine. Unfortunately, he got a horrible case of shingles. The infection cleared. But more than 20 months later, he still battles the after effects. To say shingles nerve pain has impacted his quality of life would be an understatement.
Dealing with a painful, blistery, ugly rash encircling your body is hard enough. But the pain of shingles can linger long after the rash clears.
“In some people, shingles nerve pain may take years to subside. Or it may never go away,” says UVA Health infectious disease specialist Tania Thomas, MD.
Nerve Pain: Most Common Complication of Shingles
Nerve pain is the most common complication of shingles. The formal name for shingles nerve pain is postherpetic neuralgia (PHN). What causes PHN? Nerves damaged by the vaccine-preventable herpes zoster virus.
“Pain occurs in the skin that was initially affected by the shingles rash,” says Thomas. “It can be a mild, lingering pain or an abnormal sensation when touching the skin. For other people, it can be persistent, burning, or shooting pain that can be really disruptive to daily life.”
Who's at Greatest Risk for Lasting Shingles Nerve Pain?
Persistent nerve pain after a shingles infection is more common than you might think. Around 10 to 18% of people who get shingles will experience PHN. In most people, shingles nerve pain goes away on its own after a few months. But when this pain lingers, it can be challenging to manage.
Risk factors for this complication include:
- Advanced age
- Compromised immune system
- Medical conditions like diabetes, asthma, or arthritis
Shingles Vaccine: Your Best Shot to Prevent Shingles Nerve Pain
The best way to prevent PHN is to avoid getting shingles in the first place. In other words, get the vaccine against herpes zoster virus.
Do you need the shingles vaccine? Yes, if you're 50 and older, recommends the U.S. Centers for Disease Control and Prevention. The vaccine is 97% effective in preventing shingles and 91% effective in preventing PHN in adults ages 50-69, studies show.
The latest shingles vaccine — Shingrix — has a couple of benefits compared to the previous vaccine.
- It’s more potent and durable.
- It’s not a live virus, so it's suitable for people who have a compromised immune system.
Shingrix is given in 2 doses, like the COVID vaccine. Unlike previous shingles vaccines, this newer version is more widely available at pharmacies rather than a doctor’s office.
“If you previously got Zostavax, the old version of the vaccine, you should get revaccinated with Shingrix, the new, 2-dose version,” says Thomas. “If you have any questions or concerns, talk to your primary care doctor.”
Should You Get Vaccinated After a Shingles Infection?
Yes, vaccination is still important even if you’ve had shingles. However, Thomas says there's no official guidance on how long you should wait. At the very minimum, she recommends waiting until the shingles rash goes away before you get vaccinated.
“When you develop shingles, your body produces more antibodies to fight that infection. You get immunity, but it wanes over time,” says Thomas.
That means it’s possible to get shingles again. This is rare — only about 5% of people have a repeat infection. But you don’t want to be one of them. “Waiting to get the vaccine a year after an active shingles infection, when immunity has likely waned, is a reasonable option to protect yourself from a repeat infection,” assures Thomas.
How Do You Treat Shingles Nerve Pain?
There is no cure for PHN, so doctors have to try to find a way to keep the pain in check. “It can be frustrating because it can take a long time to get patients to a comfortable place,” says Thomas.
There are a couple of treatment strategies doctors try first to relieve PHN.
- Anti-Seizure Drugs
The most common oral medications doctors prescribe are drugs for seizure disorders. These can also help relieve nerve pain. They include gabapentin and pregabalin. It can take some time to figure out the right dosage, but these drugs work for most people once they take full effect, according to Thomas.
If seizure medications don’t work, doctors may prescribe a low-dose tricyclic antidepressant, which can help with nerve-related pain.
This is a local anesthetic that blocks pain signals and numbs the skin. You can get most lidocaine creams and patches over the counter.
Capsaicin is what makes chili peppers hot or spicy. It also numbs the skin, which can help relieve PHN pain. You can get creams or patches with capsaicin over the counter. Or your doctor can prescribe stronger ones. If you try a capsaicin cream, Thomas stresses you should wear gloves when you put it on.
If none of these treatments work, Thomas says the next step may include seeing a pain specialist. “Some people may benefit from a nerve block for temporary pain relief,” she says. “This requires a referral to a pain specialist or anesthesiologist who specializes in pain management.”
Vaccines Aren't Just for Kids
Talk to a doctor who treats older adults to find out which vaccines you need.
Will Shingles Ever Be Obsolete?
Unfortunately, shingles cases are on the rise worldwide. And more younger people are getting the virus. This is in spite of our efforts to vaccinate kids against chickenpox.
Remember, shingles happens because the varicella virus, which causes chickenpox, stays in the body and can come back years later. Vaccinating kids against varicella virus should mean no more chickenpox and no more shingles. But chickenpox vaccination is fairly new; it began around 20 years ago. And not everyone is on board with vaccination.
“The vaccine is not used everywhere in the world. And there are pockets of people who don’t get the vaccine or don’t respond to it here in the U.S.,” says Thomas. “So I think it will be many decades before this virus disappears, if at all.”