How to Treat Nerve Pain Caused by Shingles

Medically reviewed by Luba Lee, FNP-BC, MS

Last Updated: August 31, 2024 Approved

Research shows that post-herpetic neuralgia (PHN) is an extremely painful condition that sometimes occurs following the herpes zoster (shingles) virus.^{[1]
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National Health Service (UK)
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Go to source} This PHN pain occurs in the areas on the body where the shingles rash was present. Generally, this pain follows a nerve’s path on one side of the body. While a painful, itchy blistering rash is the main characteristic of shingles, this nerve pain may precede its appearance. Quite frequently, the earliest symptom of shingles is a burning or tingling sensation on the skin. Experts note that the best way to treat this nerve pain is to heal your shingles, control your pain, and decrease your risk of complications.^{[2]
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Part 1

Part 1 of 5:

Reducing Pain and Itching

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1
Try to keep from scratching at your blisters. As difficult as it may be, leave your blisters alone and avoid scratching. They will crust over and then fall off on their own. If you scratch them, they will open up and become more susceptible to infection.^{[3]
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- You will also spread bacteria with your hands if you scratch at the blisters. If this does happen inadvertently, always wash your hands afterward to stay hygienic.
2
Use a baking soda paste to reduce irritation. Baking soda has a pH greater than 7 (making it alkaline), giving it the ability to neutralize the chemical that creates the itching sensation. The chemical creating the itching sensation is acidic with a pH that is less than 7.^{[4]
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- Apply a paste made of 3 teaspoons baking soda mixed with 1 teaspoon of water. This relieves itching and helps the blisters dry out quicker.
- You can apply this paste as often as needed to relieve the itching.
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3
Apply a cold compress to your blisters. Use a cool, moist compress to ease discomfort. You can apply this compress for up to 20 minutes at a time, several times a day.^{[5]
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Johns Hopkins Medicine
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- You can make a cold compress by wrapping an ice block in a clean towel and pressing it against your skin. Alternatively, you can use a bag of frozen vegetables. Just make sure not to put it directly on your skin and not to keep it on your skin for more than 20 minutes at a time as both of these conditions can lead to tissue damage.
4
Spread Benzocaine cream on your blisters after you remove the cold compress. Apply a topical cream, such as nonprescription benzocaine cream, directly after your cool compress application. Benzocaine works as an anesthetic, numbing the nerve endings in the skin.^{[6]
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- As an alternative, talk to your doctor about prescription 5% Lidocaine patches. You can apply the patch to the area where you're experiencing the pain, as long as your skin is intact. You can apply as many as 3 patches at once. You can wear your patches for up to 12 hours in a 24 hour period.

Part 2

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Dealing with Infected Sores

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Look out for signs that your sores are infected. Infected sores are bad news, so if you think that your sores may be infected, you should contact your doctor immediately.^{[7]
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Cleveland Clinic
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Go to source} Signs that your sores are infected include:
- A fever
- An increase in inflammation that causes additional pain
- The sore feels warm to the touch
- The sore is shiny and smooth
- Your symptoms are getting worse
2
Soak your infected sores in Burow’s solution. You can soak any infected sores in Burow’s solution (commercial name, Domeboro) or tap water. This helps to decrease oozing, clean away any crusting and soothe the skin.^{[8]
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- Burow’s solution has antibacterial and astringent properties. You can purchase it without a prescription at your local pharmacy.
- Instead of soaking your sores, you can also apply the Burow’s solution directly onto your sores via the cold compress. You can apply the compress for up to 20 minutes, several times a day.
Once a lesion has crusted over, you can apply capsaicin cream (e.g. Zostrix) to it. You can apply the capsaicin cream up to 5 times a day in order to promote healing.^{[9]
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DermNet NZ
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Taking Medications After the Blisters are Gone

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Use a lidocaine patch. After the blisters have healed, you can apply a 5% lidocaine patch to your skin to reduce nerve pain. The lidocaine patch provides effective pain relief without the risk of negative side effects.^{[10]
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- These are available at most pharmacies and online. Stronger patches may be available through your doctor.
2
Take non-steroidal, anti-inflammatory drugs to ease your pain. Non-steroidal anti-inflammatory medications (NSAIDs) are often prescribed in addition to other narcotic medications in order to boost pain relief. They are inexpensive and odds are you already have at least one in your bathroom cabinet.^{[11]
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American Academy of Family Physicians
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- Examples of NSAIDs include acetaminophen, ibuprofen or indomethacin. These medications can be taken up to three times per day – just be sure to follow the label for instructions on the appropriate dosage for you.
3
Try corticosteroids to relieve your nerve pain. Corticosteroids are often prescribed for relatively healthy elderly people who present with moderate to severe nerve pain. The corticosteroids are often prescribed in addition to antiviral medications.^{[12]
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- Talk to your doctor about this option. Effective (that is, stronger) corticosteroids are available by prescription only.
4
Talk to your doctor about taking narcotic analgesics. Narcotic analgesics are sometimes prescribed to treat severe nerve pain caused by shingles. However, narcotics only provide symptomatic relief – they do not treat the cause of the pain.^{[13]
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- In addition, narcotics are addictive substances which the patient can quickly become dependent on. Therefore their use must be carefully monitored by a physician.
Sometimes tricyclic antidepressants are prescribed to treat specific types of nerve pain caused by shingles. Although their exact mechanism is unknown, they work by blocking pain receptors in the body.^{[14]
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American Academy of Family Physicians
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6
Take anti-epileptic drugs to treat nerve pain. Antiepileptic drugs are widely used in pain clinics to treat neuropathic pain. There are many types of antiepileptic drugs, such as phenytoin, carbamazepine, lamotrigine and gabapentin, any of which may be prescribed to treat nerve pain in shingles patients.^{[15]
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American Academy of Family Physicians
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- For the above two steps, your doctor will know if these are viable treatments for you. In general, these two are reserved for more serious cases of nerve pain.

Part 4

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Treating Nerve Pain with Surgical Procedures

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1
Get an alcohol or phenol injection. One of the simplest surgical techniques for relieving nerve pain is an injection of alcohol or phenol into the peripheral branch of the nerve. This causes permanent damage to the nerve, thus helping to prevent pain.^{[16]
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PubMed Central
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- This is a procedure done by a medical professional. Your health history and condition will determine if this is a suitable route to pursue.
2
Try transcutaneous electrical nerve stimulation (TENS). This treatment involves the placement of electrodes over the nerves that are causing the pain. These electrodes deliver tiny, painless electrical impulses to nearby nerve pathways.^{[17]
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Cleveland Clinic
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- Exactly how these impulses relieve pain is uncertain. One theory is that the impulses stimulate the production of endorphins, your body’s natural painkillers.
- Unfortunately, this treatment doesn’t work for everyone, but it tends to be more effective if it is given in conjunction with a drug called pregabalin.
3
Consider spinal cord or peripheral nerve stimulation. These devices are similar to TENS, but are implanted ‘’underneath’’ the skin. Like TENS units, you can turn these units on and off as needed to control pain.^{[18]
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PubMed Central
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- Before the device is surgically implanted, doctors do a trial first using a thin wire electrode. The trial is done to ensure that the stimulator will provide effective pain relief.
- The electrode is inserted through your skin into the epidural space over the spinal cord for a spinal cord stimulator, or under your skin above a peripheral nerve in the case of a peripheral nerve stimulator.
This a very safe and effective form of pain relief that uses radiofrequency to modulate pain at a molecular level. After a single treatment, the pain relief can last for up to 12 weeks.

Part 5

Part 5 of 5:

Combating Shingles Before It Appears

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1
Know the symptoms of shingles. Shingles first presents as pain, itching and tingling of the skin. Sometimes these initial symptoms are followed by confusion, fatigue, fever, headache, memory loss, an upset stomach and/or stomach pain.^{[19]
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Centers for Disease Control and Prevention
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- Up to five days after the appearance of these initial symptoms, a painful rash may appear on one side of the face or body.
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Visit your doctor within 24 to 48 hours if you think you have shingles. If you think you have shingles, visit your physician within 24 to 48 hours. Antiviral drugs like famciclovir, valtrex and acyclovir can be used to effectively treat the symptoms of shingles, but only if they are started within 48 hours of onset.^{[20]
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- If you begin taking your antiviral medication after 48 hours, it may not be as effective. Additionally, keep in mind that your antivirals won't prevent PHN.
3
Use a topical medication to clear the shingles up before they get worse. In addition to antiviral medications, your physician may prescribe a topical medication, such as caladryl. Caladryl may help your already open lesions by reducing pain and itching.
- Caladryl works by interfering with the pain signals the nerves send to the brain and is available in gel, lotion, spray or stick form.
- Caladryl may be applied every 6 hours, up to 4 times a day. You need to wash and dry the affected area prior to application.
- As another option, ask your doctor about prescription 5% Lidocaine (Lipoderm) adhesive patches. You can apply the patches to intact skin to help manage your pain.
- For an over-the-counter option, use capsaicin cream (Zostrix, Zostrix HP). Apply the cream to intact skin 3 to 4 times per day. The cream may cause a burning or stinging sensation when you apply it, but this side effect should go away. If it doesn't, stop using the cream. Be sure to wash and dry your hands thoroughly after you apply the cream.^{[23]
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4
Talk to your doctor about oral medications for PHN. Your doctor can prescribe gabapentin (Neurontin) or pregabalin (Lyrica) to help manage your PHN symptoms. You can use the medication for up to 6 months, though your doctor will taper you off early if your symptoms go away before the 6 month mark. Do not stop taking the medication suddenly. Your doctor will help you taper off of it.
- All drugs have side effects. Possible side effects of these medications include memory issues, sedation, electrolyte imbalances, and liver issues. Talk to your doctor if you experience any side effects.^{[24]
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5
Ask your doctor if corticosteroid therapy is right for you. If you have moderate to severe pain caused by your outbreak, your doctor may prescribe the oral corticosteroid prednisone, along with acyclovir. Corticosteroid therapy may reduce your nerve pain, but it doesn't work for everyone.^{[25]
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American Academy of Family Physicians
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- Your doctor will only prescribe corticosteroids if you aren't taking medications that interact with them. Make sure you tell your doctor about any other medications you are taking.
- For example, your doctor might prescribe up to 60 mg of prednisone for up to 10-14 days, tapering you off before you stop taking the medication.

Expert Q&A

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Question

Can a heat pad/source help?

Luba Lee, FNP-BC, MS
Board-Certified Family Nurse Practitioner
Luba Lee, FNP-BC is a Board-Certified Family Nurse Practitioner (FNP) and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support (PALS), Emergency Medicine, Advanced Cardiac Life Support (ACLS), Team Building, and Critical Care Nursing. She received her Master of Science in Nursing (MSN) from the University of Tennessee in 2006.

Luba Lee, FNP-BC, MS

Board-Certified Family Nurse Practitioner

Expert Answer

It's better to use a cool treatment. You can run cool tap water over the affected area or soak the area in either cool water or Domeboro soaks. Soak the area several times a day for up to 20 minutes at a time. This can help clean your skin and control your pain.

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Question

How do I prevent getting shingles a second time?

Luba Lee, FNP-BC, MS
Board-Certified Family Nurse Practitioner
Luba Lee, FNP-BC is a Board-Certified Family Nurse Practitioner (FNP) and educator in Tennessee with over a decade of clinical experience. Luba has certifications in Pediatric Advanced Life Support (PALS), Emergency Medicine, Advanced Cardiac Life Support (ACLS), Team Building, and Critical Care Nursing. She received her Master of Science in Nursing (MSN) from the University of Tennessee in 2006.

Luba Lee, FNP-BC, MS

Board-Certified Family Nurse Practitioner

Expert Answer

Anyone who has experienced one or more shingles breakout is at risk for another one. Your immunity from the virus diminishes over time, so your risk remains. Getting a Zoster vaccine can provide added protection, so ask your doctor when the right time to get vaccinated is. There is no specified time to get vaccinated after a breakout, so your doctor will make a recommendation based on your medical history.

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Warnings

If you suspect you may have shingles, it is essential that you speak with your physician and get your pain managed as soon as possible. Doing so could prevent nerve damage. The nerve damage is what causes the pain that continues for months or even years.

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