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Postherpetic neuralgia - aftercare

Postherpetic neuralgia is pain that continues after a bout of shingles. This pain may last from months to years.

Shingles is a painful, blistering skin rash that is caused by the varicella-zoster virus. This is the same virus that causes chickenpox. Shingles is also called herpes zoster.

What to expect

Postherpetic neuralgia can:

  • Limit your everyday activities and make it hard to work.
  • Affect how involved you are with friends and family members.
  • Cause feelings of frustration, resentment, and stress. These feelings may make your pain worse.

Taking pain medicines

Even though there is no cure for postherpetic neuralgia, there are ways to treat your pain and discomfort.

You can take a type of medicine called NSAIDs. You do not need a prescription for these.

  • Two kinds of NSAIDs are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
  • If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your health care provider before using these medicines.

You may also take acetaminophen (such as Tylenol) for pain relief. If you have liver disease, talk with your health care provider before using it.

Your health care provider may prescribe a narcotic pain reliever. You may be advised to take them:

  • Only when you have pain
  • On a regular schedule, if your pain is hard to control

A narcotic pain reliever can:

  • Make you feel sleepy and confused. Do not drink alcohol or use heavy machinery while you are taking it.
  • Make your skin feel itchy.
  • Make you constipated (unable to have a bowel movement easily). Try to drink more fluids, eat high-fiber foods, or use stool softeners.
  • Cause nausea, or make you feel sick to your stomach. Taking the medicine with food may help.

Other medicines for postherpetic neuralgia

Your health care provider may prescribe skin patches that contain lidocaine (a numbing medicine). These may relieve some of your pain for a short time. Lidocaine also comes as a cream that can be applied to areas where a patch is not easily applied.

Zostrix, a cream that contains capsaicin (an extract of pepper), may also reduce your pain.

Two other types of prescription drugs may help reduce your pain. You must take them every day, and they may take several weeks before they begin to help.

  • Anti-seizures drugs. Gabapentin and pregabalin are the ones that are used most often.
  • Drugs to treat pain and depression, most often ones called tricyclics, such as amitriptyline or nortriptyline

Both of these types of drugs have side effects. If you have uncomfortable side effects, do not stop taking your medicine without talking with your health care provider first. Your provider may change your dosage or prescribe a different medicine.

Sometimes, a nerve block can be used to temporarily reduce pain. Your provider will tell you if this is right for you.

What else can help?

Many non-medical techniques can help you relax and reduce the stress of chronic pain, such as:

  • Meditation
  • Deep-breathing exercises
  • Biofeedback
  • Self-hypnosis
  • Muscle-relaxing techniques

A common type of talk therapy for people with chronic pain is called cognitive behavioral therapy. It may help you learn how to cope with and manage your responses to pain.

When to call the doctor

Call your health care provider if:

  • Your pain is not well-managed
  • You think you may be depressed or are having a hard time controlling your emotions


Cohen J. Varicella-Zoster virus (chickenpox, shingles). In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 383.

Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, MO: Elsevier Mosby; 2009:chap 12.

Update Date 5/28/2014

Updated by: Joseph V. Campellone, MD, Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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