Postherpetic Neuralgia (PHN): What It Feels Like and What Helps
Postherpetic neuralgia (PHN) is the long-lasting nerve pain that can follow a shingles outbreak. It feels like burning, stabbing, numbness or electric shocks in the same area where the rash was. If pain lasts more than three months after the rash heals, doctors usually call it PHN. Older people and anyone who had a severe shingles rash are more likely to get it.
You need a clear plan fast because PHN can steal sleep, mojo, and quality of life. Start by seeing a doctor who knows nerve pain. Diagnosis is usually clinical: your history of shingles plus persistent localized pain. Basic checks rule out other causes. If pain is unusual or spreading, ask for a referral to a pain specialist or neurologist.
Treatments that work
Treatment mixes medicines, topical care, and self-help. First-line meds include gabapentin or pregabalin; they calm nerve activity and work for many people. Tricyclic antidepressants such as amitriptyline or nortriptyline help too, but watch for dry mouth, drowsiness, and interactions. Topical lidocaine patches give local relief with fewer side effects. High-concentration capsaicin patches can also reduce pain but may sting initially and usually require clinic application.
If pills and patches fail, nerve blocks, steroid injections, or spinal treatments may help in selected cases. Some people respond to TENS (transcutaneous electrical nerve stimulation) or acupuncture. A pain clinic can offer targeted options like pulsed radiofrequency or neuromodulation when conservative care fails.
Self-care and prevention
Practical daily tips make a big difference. Keep the affected area protected from tight clothing and drafts. Use gentle skin care—mild soap, moisturizers, and sunscreen if the area saw a rash. Heat pads or cool packs often reduce sudden flares; try both to see which helps. Manage sleep and stress because tiredness and anxiety amplify pain. Short walks and gentle stretching improve mood and reduce stiffness.
Start low and go slow with medications. Side effects are common, so adjust dose with your doctor. If you take blood thinners or other heart medicines, tell your prescriber - some PHN drugs interact. For older adults, lower doses reduce dizziness and falls.
Vaccination is prevention. The shingles vaccine (Shingrix) dramatically cuts the risk of shingles and postherpetic neuralgia in adults. If you haven't had it, ask your primary care doctor about getting vaccinated.
If pain is severe or driving you toward depression, get help fast. Pain clinics, mental health support, and physical therapy all play roles. Combining methods usually works better than using only one.
PHN can be stubborn, but many people find meaningful relief. The goal is less pain, better sleep, and getting back to life. Keep notes on what helps, share them with your doctor, and don't accept "wait it out" when better options exist.
If you're starting treatment, ask how long before changes should appear and what to do about side effects. Keep an up-to-date list of medications, and tell any new provider about your PHN history. Small fixes stack up: better sleep, steady activity, and honest communication with your care team speed recovery daily.
