Postherpetic Neuralgia (PHN): What It Is and How to Ease It

If you’ve ever had shingles, you know the rash can be nasty. For some people the pain doesn’t quit when the skin heals. That lingering hurt is called postherpetic neuralgia, or PHN. It’s basically nerve pain that sticks around after the shingles virus calms down.

Most folks feel the worst pain during the rash stage, but about 10‑20 % keep feeling burning, stabbing, or throbbing pain for weeks, months, or even years. The good news? There are ways to cut down the ache and get back to normal life.

Why PHN Happens After Shingles

Shingles is caused by the varicella‑zoster virus, the same bug that gives you chickenpox as a kid. After chickenpox clears, the virus hides in nerve roots. When it reactivates, it travels along those nerves to the skin, causing the classic rash.

During the outbreak the virus damages the nerves it travels through. If the damage is big enough, the nerves keep sending pain signals even after the rash is gone. Age plays a role – older adults have weaker nerves and are more likely to develop PHN. A severe rash and a delayed start of antiviral medicine also raise the risk.

Because the pain comes from nerve injury, it feels different from a typical cut or bruise. It can be sharp, burning, or a constant throbbing. Sometimes even light touches – like a shirt or a breeze – feel painful. That’s called allodynia, and it’s a hallmark of PHN.

Ways to Treat and Manage PHN

First‑line treatment usually starts with medicines that affect nerve signals. Anticonvulsants such as gabapentin or pregabalin are popular because they calm down over‑active nerves. Many people find relief with low doses that are gradually increased.

Tricyclic antidepressants (like amitriptyline) also help. They work on the same nerve pathways and can lower the pain’s intensity. If you’re already taking an antidepressant for mood, ask your doctor if the dose can help with PHN too.

Topical options are great if you prefer something you can apply directly. Creams or patches with lidocaine numb the skin, while capsaicin creams desensitize the nerve endings over time. Use them as directed – they can cause a brief sting before they help.

For stubborn cases, doctors may prescribe a short course of steroids or a nerve block injection. These aren’t first‑line because of side‑effects, but they can break a pain cycle that won’t respond to oral meds.

Don’t forget non‑drug strategies. Gentle exercise keeps blood flowing and can reduce stiffness. A daily walk, light stretching, or yoga are safe choices. Applying a warm compress or taking a warm bath can soothe burning sensations.

Stress makes pain feel worse, so try relaxation techniques. Deep breathing, meditation, or even listening to calming music can lower the brain’s alarm system. Getting enough sleep is a must – lack of sleep fuels pain.

Lastly, keep track of what triggers flare‑ups. Some people notice that caffeine, alcohol, or extreme temperatures make the pain spike. A simple diary helps you spot patterns and avoid the culprits.

PHN can be frustrating, but you don’t have to suffer in silence. Talk to your healthcare provider about starting a nerve‑targeting medication, try a topical cream, and add gentle movement to your day. With the right mix of treatments, the pain can fade and you can get back to doing the things you enjoy.