Postherpetic Neuralgia (Shingles Nerve Pain)
Postherpetic neuralgia is the burning, stabbing nerve pain that persists long after a shingles outbreak resolves — one of the most painful and undertreated chronic pain conditions, and one that responds well to targeted interventional treatment.
What Is Postherpetic Neuralgia?
When shingles reactivates, the virus travels along nerve fibers and damages them as it moves toward the skin surface — producing the characteristic rash and blistering. In some patients, this nerve damage persists long after the rash heals, causing chronic pain that can last months or years. This persistent pain is called postherpetic neuralgia.
PHN is most common in older adults and can be severely debilitating. The pain is typically described as burning, stabbing, or electric shock-like, and many patients experience extreme sensitivity to touch — even light contact with clothing can trigger significant discomfort. PHN most commonly affects the chest wall, back, or abdomen, though it can also affect the face and head depending on which nerve was involved.
How We Treat Postherpetic Neuralgia
Treatment begins with a thorough evaluation of your pain distribution, severity, and prior treatment history. Medication management targeting nerve pain is typically the first line of treatment. For patients with chest wall or rib PHN, intercostal nerve blocks can provide meaningful relief. For PHN affecting the head or neck, occipital nerve blocks may be appropriate.
A series of nerve blocks is typically more effective than a single injection for PHN. For patients with severe or refractory postherpetic neuralgia that has not responded adequately to medications and nerve blocks, spinal cord stimulation may be considered. A consultation is the right starting point to develop an appropriate plan.