Postherpetic neuralgia is a painful complication of shingles that affects the nerves. It results in painful sensations that continue after the rash has healed.

Postherpetic neuralgia is the most common shingles complication. It occurs when a shingles outbreak damages the nerves.

The damaged nerves can’t send messages from the skin to the brain, and the messages become confused. This results in chronic, severe pain that can last for months.

According to a 2017 review, about 20% of people who get shingles also develop postherpetic neuralgia. People who are older when they get shingles are more likely to get postherpetic neuralgia.

Shingles typically causes a painful, blistering rash. Postherpetic neuralgia involves severe pain along the nerve pathways affected by shingles.

Symptoms of postherpetic neuralgia can include:

  • severe pain that continues for more than 3 months in the same place the shingles occurred after the rash goes away
  • burning sensation on the skin, even from the slightest pressure
  • sensitivity to touch or temperature changes

Age is a major risk factor for getting both shingles and postherpetic neuralgia. Risk begins to increase at age 50 and rises the older you get.

Some research suggests that postherpetic neuralgia affects 60% of those 60 or older and 75% of those 70 or older.

People who have severe pain and rash during shingles also have a higher risk of developing postherpetic neuralgia.

Most of the time, a doctor can make a diagnosis of postherpetic neuralgia based on how long you’ve experienced pain following shingles. Tests are not often needed to confirm the diagnosis. Some doctors may recommend an MRI or spinal fluid analysis.

Treating postherpetic neuralgia can be difficult. Doctors typically try to prevent it by treating severe cases of shingles, as early treatment may prevent postherpetic neuralgia.

Treatment for postherpetic neuralgia aims to manage and reduce the pain until the condition improves. Pain therapy may include the following treatments.

Analgesics

Pain relievers are also known as analgesics. They’re available over the counter (OTC) or by prescription.

Analgesics for postherpetic neuralgia can include:

  • capsaicin cream, an analgesic extracted from hot chile peppers
  • lidocaine patches, a numbing medication
  • OTC medications, such as acetaminophen (Tylenol) or ibuprofen (Advil)
  • stronger prescription drugs, such as codeine, hydrocodone, or oxycodone

Tricyclic antidepressants

Some doctors may prescribe tricyclic antidepressants to treat pain caused by postherpetic neuralgia.

Tricyclic antidepressants can have side effects, like dry mouth and blurred vision. They don’t act as quickly as other types of pain relievers.

Tricyclic antidepressants to treat postherpetic neuralgia may include:

  • amitriptyline (Elavil)
  • desipramine (Norpramin)
  • imipramine (Tofranil)
  • nortriptyline (Pamelor)

Anticonvulsants

Doctors may prescribe anticonvulsants to treat postherpetic neuralgia pain. Commonly used anticonvulsants include:

  • gabapentin (Neurontin)
  • carbamazepine (Tegretol)
  • pregabalin (Lyrica)
  • phenytoin (Dilantin)

Doctors typically try to prevent postherpetic neuralgia in people with shingles by treating severe cases. Early treatment may prevent postherpetic neuralgia.

You can also prevent postherpetic neuralgia by preventing shingles.

Two doses of a herpes zoster vaccine called Shingrix reduce the risk of shingles by more than 90%. The vaccine also protects against postherpetic neuralgia.

The Centers for Disease Control and Prevention (CDC) recommends healthy people ages 50 and up get the Shingrix vaccine.

What does postherpetic neuralgia feel like?

Postherpetic neuralgia can cause pain and burning sensations in the area of the shingles rash after it has healed.

How is postherpetic neuralgia treated?

Treatment for postherpetic neuralgia typically involves topical and oral pain relief medications. Doctors may also prescribe other medications to relieve nerve pain, including antidepressants and anticonvulsants.

How do you fix nerve damage after shingles?

Nerve pain that lasts after shingles, also known as postherpetic neuralgia, typically improves over time. Doctors may recommend medications to reduce pain.

How long can postherpetic neuralgia last?

Postherpetic neuralgia can last for months to years. Treatment may help reduce pain.

Postherpetic neuralgia is treatable and preventable. Most pain lessens over time. In rare cases, it can last longer than a year.

If you’re older than 50, experts recommend getting vaccinated against shingles.

If you do develop postherpetic neuralgia, treatment options may help manage the pain. Talk with a doctor to find the best treatment for you.