A better phrase for this is post-herpes (shingles)
nerve-pain. Awful. Unrelenting. Who gets this? How to make it better?

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The main risk factor for postherpetic neuralgia is increasing age. People under 50 have long-term pain rarely. Those who are 60-65 20% get it and 30% of those greater than 80 years have long-term nerve pain. 2% of those with acute herpes zoster have pain for 5+ ears. Other risk factors for postherpetic neuralgia are

• severe pain with the shingles infection,
• a severe shingles rash,
• fever and muscle aches with the rash, and
• stress.

What can we do about this?

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When you get a rash that may itch, feel like bugs-under-your-skin, or burn see your doctor immediately. If it is herpes zoster and antiviral medication is started immediately, this may reduce the duration of postherpetic neuralgia when compared to placebo (sugar pills). Topical lidocaine, a cream, may help in treating nerve pain.

Can we prevent postherpetic neuralgia? Yes! The herpes zoster vaccine is used for the primary prevention of herpes zoster (meaning. . . it is used so that you never get the infection/rash to start with) and it helps decrease your risk of postherpetic neuralgia in people older than 60. It is one vaccine, given in your muscle. One and done!

Many medicines we used to think were helpful, are now known to not be helpful. The most important of these is steroids. Not helpful in the acute attack of shingles and it has unknown effectiveness with long-term nerve pain. Those with unknown effectiveness in studies are topical antivirals, gabapentin, oral opioid pain medication, amitriptyline, capsaicin cream, SSRIs and SNRI (antidepressant medication).

Take home points:

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If you are older than 60, ask your doctor and insurance company about coverage for herpes zoster vaccine. If you get a suspicious rash, call your doctor immediately for an appointment.