How to Treat Postherpetic Neuralgia: 4 Steps for Fast and Safe Pain Relief

Postherpetic neuralgia (PHN) is one of the most debilitating complications that can occur after the shingles rash has healed. Statistics show that approximately 10–18% of people who contract shingles may develop PHN, with the risk increasing significantly in individuals over 50 years of age. The pain can last for months or even years, leading to sleep deprivation, reduced work capacity, and a severe impact on quality of life.

If you are looking for ways to treat shingles and alleviate the persistent burning, stinging, or tingling sensation after shingles, this article will help you understand the causes, common shingles medications prescribed by doctors, as well as home care measures to manage symptoms and limit complications. Tiptory will also share important tips for proper treatment, faster recovery, and reducing the risk of pain recurrence.

Part 1: How to Relieve Shingles Pain and Itching Quickly

Step 1: Avoid scratching the affected area

Do not scratch or break shingles blisters

• Even though the itching, stinging, or burning sensation can be very uncomfortable, you should minimize scratching the blisters. This is one of the crucial principles when treating shingles and caring for the affected skin.

• The blisters will dry, scab over, and then peel off naturally during the healing process. If you intentionally scratch or pick at the scabs, the skin can tear, slowing down healing and increasing the risk of scarring.

• When blisters break, bacteria can easily enter the compromised skin, increasing the risk of skin infection. This not only prolongs treatment but can also make postherpetic neuralgia more severe in some cases.

• If the itching is too intense, consult your doctor for advice on itch relief measures or appropriate medication instead of scratching.

Keep hands clean to prevent infection

• Bacteria from your hands can adhere to blisters if you accidentally touch or scratch the shingles-affected area.

• If you accidentally touch or scratch the affected area, wash your hands immediately with soap and clean water to reduce the risk of introducing bacteria to the wound or spreading it to other skin areas.

• In addition to frequent hand washing, you should also keep your nails short and clean to avoid scratching the skin if you accidentally touch the rash.

• Maintaining hand hygiene and proper care will support the shingles treatment process, helping skin lesions heal smoothly and reducing the risk of complications.

Step 2: Use baking soda to relieve shingles itching

Apply a baking soda mixture to soothe itching

• If the shingles-affected skin is very itchy, you can try using a baking soda mixture to help soothe irritation. Some studies suggest that baking soda is alkaline, which can help neutralize the acidic environment on the skin's surface, thereby contributing to reduced itching in some individuals.

• Mix 3 teaspoons of baking soda with 1 teaspoon of water to create a paste. Gently apply a thin layer to the affected skin, avoiding vigorous rubbing or breaking the blisters.

• In addition to providing temporary itch relief, this mixture can also help keep the affected surface drier, facilitating blister scabbing during the shingles treatment process.

Use correctly to avoid skin irritation

• You can apply the mixture multiple times a day when itching occurs, as long as the skin shows no signs of irritation or increased burning pain.

• Do not apply to bleeding skin, areas with signs of infection, or large open wounds, as this can cause discomfort and slow down the healing process.

• If, after use, the skin becomes redder, hotter, or more itchy, discontinue use and consult a doctor.

• Baking soda is only a supportive measure for symptom relief and does not replace shingles medication or treatments prescribed by a doctor. If the pain persists or postherpetic neuralgia develops, you should seek medical attention for evaluation and appropriate treatment.

Step 3: Apply a cold compress to relieve shingles pain and itching

Cold compress helps soothe shingles-affected skin

• Applying a cold compress is a simple way to reduce the burning pain, itching, and discomfort caused by shingles blisters. Cool temperatures can temporarily constrict blood vessels, reduce mild inflammation, and soothe nerve endings on the skin's surface.

• Place a cool compress on the affected skin for about 15–20 minutes at a time, then let the skin rest before reapplying. You can do this multiple times a day if you still experience pain or itching.

• This is a helpful supportive measure during shingles treatment, especially in the early stages when blisters are fresh and causing significant discomfort.

Apply compress correctly to avoid skin damage

• You can wrap ice in a clean cloth and gently apply it to the shingles-affected area. Alternatively, a bag of frozen vegetables wrapped in a soft cloth can also be used as a compress if you don't have an ice pack.

• Do not place ice or frozen packs directly on the skin, as excessively low temperatures can cause frostbite and tissue damage.

• Do not apply compresses continuously for more than 20 minutes at a time to limit the risk of skin and blood vessel damage.

• If the skin shows signs of infection, significant fluid discharge, or if the pain becomes increasingly severe, seek medical attention for advice on shingles medication and appropriate treatment methods to reduce the risk of prolonged postherpetic neuralgia.

Step 4: Apply pain-relieving creams correctly

Apply topical anesthetic cream for temporary pain relief

• After applying a cold compress, you can use over-the-counter topical anesthetic cream containing benzocaine, following the instructions for use, to help reduce pain, burning, or stinging sensations on the shingles-affected skin.

• Benzocaine works by temporarily numbing local nerve endings, thereby helping to reduce discomfort for a short period.

• Apply only a thin layer to the affected area and avoid contact with eyes, mouth, or other mucous membranes.

• If signs of irritation such as redness, swelling, or rash appear after using the cream, discontinue use and consult a doctor.

Discuss lidocaine patches with your doctor

• If the pain persists or affects daily activities, your doctor may prescribe a 5% lidocaine patch to help relieve pain, especially for those with postherpetic neuralgia.

• The patch should only be applied to intact skin, without open wounds or broken blisters.

• According to treatment guidelines, a maximum of 3 patches can be applied simultaneously to the painful area and should not be used for more than 12 hours within a 24-hour period, unless otherwise instructed by a doctor.

• Do not arbitrarily extend the duration of use or increase the number of patches, as this can increase the risk of side effects.

Notes on using topical pain relievers

• Topical creams or lidocaine patches only help control symptoms and do not kill the virus that causes shingles.

• For effective shingles treatment, you should combine proper skin care with shingles medication or antiviral drugs as prescribed by your doctor. Early treatment also helps reduce the risk of developing or prolonging postherpetic neuralgia.

Part 2: Treating Infected Shingles Wounds

Step 1: Recognize signs of infected shingles

Monitor for signs of infection in the shingles-affected skin

• During shingles treatment, observe the affected skin daily. If the blisters or lesions become infected, you need to seek medical attention for timely examination and treatment.

• Infection can cause wounds to heal slower, increase the risk of scarring, and complicate the recovery process.

Warning signs that require early medical attention

• Fever or chills, more fatigue than usual.

• The shingles-affected area becomes redder, more swollen, and the pain increases instead of decreasing over time.

• The skin around the lesion feels hotter to the touch, with a distinct burning sensation.

• The surface of the lesion becomes shiny, abnormally taut, or shows increased discharge.

• Symptoms worsen, blisters spread, or there are no signs of improvement after several days of treatment.

Do not self-treat if infection is suspected

• If one or more of the above signs appear, contact your doctor as soon as possible. Depending on the specific condition, your doctor may prescribe appropriate medication to control the infection and adjust the shingles treatment regimen if necessary.

• Do not arbitrarily apply many types of creams or puncture blisters, as this can increase the risk of infection and prolong the recovery time.

• Correct and timely treatment not only helps skin lesions heal faster but also contributes to reducing the risk of prolonged postherpetic neuralgia after the disease has resolved.

Step 2: Soak the skin with Burow's solution

Clean the affected skin with Burow's solution

• If the shingles-affected skin has a lot of discharge or your doctor determines there are signs of infection, you may be instructed to use Burow's solution (Domeboro) to aid in topical care.

• Burow's solution contains aluminum acetate, which has astringent properties, helping to reduce discharge, clean scabs, and soothe irritated skin.

• In the absence of Burow's solution, your doctor may recommend gently washing the skin with clean water to assist with wound hygiene, depending on the specific condition.

Soak or compress correctly

• You can gently soak the affected skin in Burow's solution according to your doctor's instructions or the product label.

• Another option is to soak a clean cloth in the solution and apply a cool compress to the shingles-affected area for about 15–20 minutes at a time, doing this multiple times a day if needed to reduce discomfort.

• After soaking or compressing, let the skin air dry naturally or pat it gently with a clean cloth, avoiding vigorous rubbing on the blisters.

Notes on using Burow's solution

• Burow's solution only helps with topical wound care and does not replace shingles medication or antiviral drugs prescribed by a doctor.

• If the skin develops pus, widespread redness, increased pain, fever, or if symptoms worsen, seek medical attention for evaluation and timely treatment.

• Combining proper skin care with the shingles treatment regimen will help wounds heal faster and contribute to reducing the risk of prolonged postherpetic neuralgia.

Step 3: Use capsaicin cream after scabbing

Only use capsaicin cream when the lesion has scabbed over

• After the shingles blisters have completely dried and scabbed over, you can discuss with your doctor or pharmacist about using capsaicin cream to help relieve pain, especially when there are signs of postherpetic neuralgia.

• Capsaicin is an active ingredient derived from chili peppers that works by gradually reducing the ability of nerve endings to transmit pain signals, thereby helping to alleviate burning or stinging pain over time.

• Do not apply capsaicin to intact blisters, weeping skin, or open wounds, as this can cause irritation and increased pain.

Use correctly for effectiveness

• Apply a thin layer to the scabbed skin according to the instructions for use or your doctor's prescription.

• Some products can be used up to 4–5 times a day, but you should follow the instructions on the label or the advice of a healthcare professional.

• After applying the cream, wash your hands thoroughly with soap, unless the treated area is on your hands. Avoid getting the cream in your eyes, mouth, or mucous membranes, as it can cause severe irritation.

Notes on using capsaicin cream

• A mild sensation of warmth, stinging, or burning during the first few days of use is a common side effect and usually subsides with continued treatment.

• If severe burning, rash, or persistent irritation occurs, discontinue use and contact your doctor.

• Capsaicin cream is a supportive measure for symptom control and does not replace shingles medication or antiviral drugs. Combining proper treatment and appropriate skin care will help shingles treatment be more effective, while reducing the risk of prolonged postherpetic neuralgia.

Part 3: Effective Medications for Postherpetic Neuralgia

Type 1: Using lidocaine patches for pain relief

Use lidocaine patches once the skin has healed

• After the shingles blisters have completely healed and the skin no longer has open wounds, you can use a 5% lidocaine patch as prescribed by your doctor to help relieve postherpetic neuralgia.

• Lidocaine is a topical anesthetic that helps reduce pain signals from damaged nerves without affecting the entire body. This is one of the methods often recommended to manage prolonged pain after shingles.

• Only apply to intact, clean, and dry skin. Do not use on areas with active blisters, abrasions, or infection.

Benefits of lidocaine patches

• Helps reduce burning, stinging, or tingling sensations caused by nerve damage.

• The medication primarily acts locally, so systemic absorption into the bloodstream is low, meaning the risk of systemic side effects is generally lower compared to many oral pain medications.

• Can help improve sleep and daily activities in those with prolonged postherpetic neuralgia.

Notes on use

• Adhere strictly to the duration and number of patches as instructed by your doctor or manufacturer.

• If the skin becomes very red, develops a rash, itches, or becomes irritated after application, discontinue use and inform your doctor.

• Lidocaine patches only help control pain symptoms and do not replace shingles medication or other shingles treatments aimed at addressing the underlying cause. If the pain persists or becomes increasingly severe, you should return for a follow-up to adjust the treatment plan accordingly.

Type 2: Using pain relievers correctly

Use pain relievers as directed by your doctor

• If the pain from shingles or postherpetic neuralgia affects daily activities, your doctor may prescribe pain relievers to control symptoms. Depending on the severity of the pain, medication can be used alone or in combination with other treatments.

• Early pain management not only helps you feel more comfortable but also improves sleep, mobility, and quality of life during shingles treatment.

Commonly used pain relievers

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or indomethacin can help relieve pain and reduce inflammation in some cases. These drugs should be used at the correct dosage and with caution in individuals with stomach, kidney, or heart conditions.

• Paracetamol (acetaminophen) is also a common pain reliever. Although not an NSAID, it can be used to relieve pain and reduce fever as prescribed or according to label instructions.

• For cases of severe or prolonged pain, especially postherpetic neuralgia, your doctor may consider specialized neuropathic pain medications instead of just common pain relievers.

Notes on medication use

• Always take medication at the prescribed dosage and duration. Do not arbitrarily increase the dose or combine multiple pain relievers without a doctor's instruction.

• Some NSAIDs can irritate the stomach, increase the risk of gastrointestinal bleeding, or affect kidney function if used improperly.

• If the pain does not improve after a few days, becomes more severe, or if side effects such as severe abdominal pain, vomiting blood, rash, or shortness of breath appear, stop the medication and seek immediate medical attention.

• Pain relievers only help control symptoms and do not replace shingles medication or antiviral drugs. Comprehensive treatment as directed by your doctor is an effective way to treat shingles and reduce the risk of prolonged postherpetic neuralgia.

Type 3: Consider prescribed corticosteroids

Corticosteroids can help relieve pain in some cases

• For some individuals with shingles experiencing moderate to severe pain, especially older adults in good overall health, doctors may consider prescribing corticosteroids to help reduce inflammation and pain.

• This medication is typically not used alone but may be combined with antiviral shingles medication to enhance treatment effectiveness in suitable cases.

• The use of corticosteroids requires careful assessment by a doctor regarding the benefits and risks for each patient.

Only use as prescribed by a doctor

• Corticosteroids are prescription drugs and should not be self-purchased or used without medical supervision, as improper use can lead to numerous side effects.

• Before prescribing, the doctor will consider factors such as age, extent of damage, underlying medical conditions (diabetes, hypertension, osteoporosis, gastric ulcers, etc.), and the risk of adverse effects.

• During treatment, take the medication at the correct dose and duration, and do not abruptly stop it unless instructed by your doctor.

Notes when treating shingles with corticosteroids

• Corticosteroids do not kill the Varicella-zoster virus and do not replace antiviral drugs in the course of shingles treatment.

• If unusual signs appear, such as prolonged fever, elevated blood sugar, severe edema, shortness of breath, or worsening symptoms while taking the medication, contact your doctor immediately.

• Early treatment with an appropriate regimen, combined with proper skin care and pain management, will help reduce the risk of prolonged postherpetic neuralgia and improve recovery.

Type 4: Opioid pain relievers for severe pain

Opioids are only considered when pain is very severe

• If postherpetic neuralgia or shingles pain is severe and unresponsive to conventional treatments, your doctor may consider prescribing opioid pain relievers (narcotic analgesics) in some cases.

• This group of drugs provides strong pain relief, helping patients improve their ability to rest and function when pain significantly affects their quality of life.

• Opioids only help control pain symptoms and do not eliminate the Varicella-zoster virus or treat the underlying cause of the disease. Therefore, patients still need to use shingles medication and other treatments as prescribed.

Use of opioids under strict medical supervision

• Opioids are prescription drugs and should only be used when a doctor determines that the benefits outweigh the risks.

• Prolonged or improper use can lead to drug dependence, tolerance, or side effects such as drowsiness, constipation, nausea, and respiratory depression.

• During treatment, adhere strictly to the dosage and duration of use. Do not arbitrarily increase the dose, use with sedatives, or suddenly stop the medication without a doctor's guidance.

Prioritize appropriate treatment methods first

• According to current treatment guidelines, opioids are typically not the first-line choice for postherpetic neuralgia. Doctors usually prioritize specialized neuropathic pain medications such as gabapentin, pregabalin, or certain appropriate antidepressants before considering opioids.

• If the pain persists despite proper treatment, revisit your doctor to adjust the shingles treatment regimen as needed, rather than self-administering strong pain relievers. This helps control pain more effectively and reduces the risk of adverse effects.

Type 5: Antidepressants for neuropathic pain

Tricyclic antidepressants can help relieve neuropathic pain

• In some cases of prolonged postherpetic neuralgia, doctors may prescribe tricyclic antidepressants (TCAs) to help manage the pain.

• Although developed to treat depression, this class of drugs has also been shown to be effective in treating many forms of chronic neuropathic pain, including post-shingles pain.

• Commonly used drugs include amitriptyline, nortriptyline, or desipramine, depending on the individual's health status and pain level.

Medication works by modulating pain signals

• The exact mechanism of action is not fully understood, but studies suggest that these drugs help increase the levels of certain neurotransmitters, such as serotonin and norepinephrine, thereby reducing the transmission of pain signals in the nervous system.

• As a result, many patients may experience a reduction in burning, sharp, or electric-shock-like pain from postherpetic neuralgia, while also improving sleep quality.

Use only as prescribed by a doctor

• Tricyclic antidepressants are prescription drugs, and a doctor must select the appropriate dose and monitor the patient throughout the treatment course.

• Some possible side effects include dry mouth, drowsiness, constipation, dizziness, or orthostatic hypotension. Older adults often need to start with a low dose to reduce the risk of adverse effects.

• Do not abruptly stop the medication as this can cause discomfort or lead to a recurrence of pain.

Combined treatment for better effectiveness

• Tricyclic antidepressants are just one part of the treatment regimen for shingles and postherpetic neuralgia. Depending on the case, the doctor may combine them with shingles medication (antivirals in the acute phase), other neuropathic pain medications, and home care measures to achieve optimal pain control and improve quality of life.

Type 6: Antiepileptic drugs for neuropathic pain

Antiepileptic drugs help control postherpetic neuralgia

• When postherpetic neuralgia is prolonged or moderate to severe, doctors may prescribe antiepileptic drugs to reduce pain.

• Although originally developed to treat epilepsy, some drugs in this class have been shown to be effective in treating neuropathic pain caused by nerve damage, including post-shingles pain.

• Commonly used drugs include gabapentin and pregabalin. In some special cases, other drugs such as carbamazepine, lamotrigine, or phenytoin may be considered, depending on the patient's condition and the doctor's assessment.

Drugs help reduce pain signals from nerves

• The drugs work by modulating the abnormal activity of nerve cells, thereby reducing the transmission of pain signals to the brain.

• Patients may notice a gradual reduction in burning, sharp, or electric-shock-like pain after a period of use. However, the effect usually does not appear immediately and may take several days to several weeks.

• For best results, the medication must be taken regularly as prescribed and doses should not be skipped arbitrarily.

Use only as prescribed by a doctor

• Antiepileptic drugs are prescription drugs, usually indicated when conventional pain relief methods are ineffective or when pain significantly interferes with daily activities.

• During treatment, the doctor may adjust the dose from low to high to optimize effectiveness and reduce side effects.

• Some possible side effects include drowsiness, dizziness, loss of balance, or mild edema. If symptoms persist or become severe, inform your doctor.

Treatment needs to be individualized

• Not all people with shingles need to use antiepileptic drugs. The doctor will base the decision on the severity of postherpetic neuralgia, age, underlying medical conditions, and current medications to choose the appropriate treatment plan.

• Combining the right shingles medication, neuropathic pain medication, and home care will help treat shingles more effectively, while reducing the risk of prolonged pain and improving quality of life.

Part 4: Medical Interventions for Postherpetic Neuralgia

Note 1: Nerve block injections for pain relief

Alcohol or phenol injections are only for special cases

• For individuals with very severe, prolonged postherpetic neuralgia that doesn't respond to conventional treatments, a specialist doctor may consider interventional techniques such as injecting alcohol or phenol into the affected nerve branch.

• The goal of this method is to disrupt the nerve's ability to transmit pain signals, thereby helping to provide long-term pain relief in some carefully selected cases.

• This is an advanced interventional measure and not a first-line treatment option for shingles.

Performed at specialized medical facilities

• Alcohol or phenol injections must be performed by a pain management or neurology specialist under sterile conditions and with close monitoring.

• Before prescribing, the doctor will assess the severity of postherpetic neuralgia, the location of the injury, overall health status, and the effectiveness of previously applied treatments.

• Patients must be fully informed about the benefits, risks, and potential complications before undergoing the procedure.

Weighing benefits and risks

• Because this method intentionally damages a portion of the nerve, it can carry potential risks such as prolonged numbness, muscle weakness, or loss of sensation in the treated area, depending on the intervention site.

• Therefore, this technique is usually only considered when methods such as shingles medication, neuropathic pain medication, lidocaine patches, or other pain relief measures have not yielded desired results.

• If you experience prolonged pain after shingles, consult a specialist to discuss the most appropriate treatment instead of seeking invasive interventions yourself. Timely and correctly indicated treatment will help control pain more effectively and limit long-term complications.

Note 2: TENS for neuropathic pain relief

TENS can help relieve post-shingles pain

• Transcutaneous Electrical Nerve Stimulation (TENS) is a non-invasive method that uses electrodes placed on the skin near the painful nerve to deliver low-intensity electrical impulses.

• These electrical impulses are usually painless and can help reduce pain sensations in some people with postherpetic neuralgia, especially when the pain persists after skin lesions have healed.

• TENS is a supportive method for symptom control and does not treat the virus causing shingles or replace shingles medication.

Mechanism of pain relief is still under investigation

• Currently, the exact mechanism of TENS is not fully understood. Theories suggest that this method can:

  • Stimulate the body to release endorphins, natural pain relievers.

  • Reduce the transmission of pain signals from the nerves to the brain according to the "gate control theory."

• The response level varies among individuals, so not everyone achieves the same effectiveness.

Effectiveness may be higher when combined with treatment

• Some studies show that TENS may be more effective when combined with neuropathic pain medications, such as pregabalin, as prescribed by a doctor.

• The choice of combined treatment will depend on the severity of postherpetic neuralgia, age, underlying medical conditions, and individual response.

Notes on using TENS

• TENS should only be performed under the guidance of healthcare professionals or rehabilitation specialists to ensure correct electrode placement and appropriate intensity selection.

• Do not place electrodes on skin with blisters, open wounds, or infections.

• People with pacemakers, implanted defibrillators, or certain other electronic devices in the body should consult a doctor before using TENS.

• During shingles treatment, TENS is often considered a supportive method alongside shingles medication, neuropathic pain medication, and other care measures to control pain and improve quality of life.

Note 3: Implanted neurostimulation devices

Spinal cord or peripheral nerve stimulation for persistent pain

• If postherpetic neuralgia is prolonged, severe, and unresponsive to medication or other treatments, a specialist may consider Spinal Cord Stimulation (SCS) or Peripheral Nerve Stimulation (PNS).

• These are modern interventional techniques that use a small device implanted under the skin to deliver mild electrical pulses, helping to modulate the transmission of pain signals to the brain.

• Patients can turn the device on or off as instructed by their doctor to control pain in their daily lives.

Trial Before Permanent Implantation

• Before deciding on a permanent device implant, the doctor will conduct a trial period by temporarily placing a thin electrode in the appropriate position.

• This period helps evaluate whether the method truly reduces pain and improves the patient's quality of life.

• Only if the trial results achieve the desired effectiveness will the doctor consider proceeding with long-term device implantation.

How is the device placed?

• For spinal cord stimulation, electrodes are inserted into the epidural space along the spinal cord to affect pain sensory pathways.

• For peripheral nerve stimulation, electrodes are placed under the skin near the pain-causing nerve to reduce pain signals in that area.

• The procedure is performed by a specialist in sterile conditions and requires post-intervention monitoring.

Applicable Only to Certain Cases

• This is an intensive treatment, usually considered only when shingles medication, neuropathic pain medication, physical therapy, and other measures fail to control postherpetic neuralgia.

• Not all patients are suitable for this technique. The doctor will thoroughly assess the patient's health, the cause of the pain, and the potential response to treatment before making an indication.

  Joseph Bennett General Practitioner

  Holds an MD from Northwestern University, with over 12 years of experience in public health and chronic disease treatment. Currently practicing at Northwestern Memorial Hospital, prioritizing safe, evidence-based treatment methods.