Shingles Pain and Prevention

Knowing what to watch for and getting vaccinated may prevent this painful condition from recurring.

Shingles is a painful condition caused by the varicella-zoster virus, the same virus that causes the chickenpox. After a person has chickenpox, the virus stays in the nerve tissue near the spinal cord and brain. For reasons that are not fully understood, years later, the virus may reactivate and cause shingles.

Shingles often causes a rash, which usually develops on one side of the body. The rash forms blisters that scab over in a 7 to 10 days. However, some people don’t develop these telltale symptoms. “It doesn’t always have a rash. And it isn’t always on one side of the body. Those are two reasons shingles can be delayed in its diagnosis and treatment,” says Houman Danesh, MD, director of Integrative Pain Management for Mount Sinai Hospital in New York.

“Shingles pain can feel like burning or tingling. Some people describe it as being like ants crawling on their skin,” Dr. Danesh says. “The pain can last for up to four months.”

According to the US Centers for Disease Control and Prevention (CDC), almost one out of every three people in the United States will develop shingles in their lifetime. There are an estimated 1 million cases of shingles each year in the United States.

Not everyone who had chickenpox will develop shingles. Those individuals with lowered immunity to infections are at increased risk. Shingles is also more common in older adults—about half of all cases occur in men and women age 60 or over.

Up to 20% of people with shingles develop post-herpatic neuralgia, an irritation of the nerves that can be debilitating. “It is so severe that it can increase the risk of suicide,” Dr. Danesh says. While post-herpatic neuralgia usually clears up in several weeks or months, in some people, the pain remains for the rest of their lives.

Several days before a shingles rash appears, a person may have pain, itching, or tingling in the area where the rash will develop. The rash usually appears in a stripe around one side of the body. In some cases, the rash appears on one side of the face. Other symptoms can include fever, headache, chills and upset stomach.

Early Treatment Is Key

While there is no cure for shingles, antiviral drugs such as acyclovir (Zovirax) or valacyclovir (Valtrex) can hasten healing and reduce the risk of complications, such as post-herpatic neuralgia. “Treating shingles early on reduces the chance it will turn into a chronic condition,” says Dr. Danesh.

There are a variety of treatments for the pain caused by shingles, as well as for post-herpatic neuralgia:

  • a capsaicin skin patch, derived from chili peppers. “The chili peppers essentially burn out the nerve that’s causing pain,” explains Dr. Danesh.
  • anti-seizure drugs, such as gabapentin (Neurontin) or pregabalin (Lyrica), which are also used to treat nerve pain
  • tricyclic antidepressants  such as nortriptyline (Pamelor), duloxetine (Cymbalta), and venlafaxine (Effexor XR), which affect brain chemicals involved in how the body interprets pain
  • a lidocaine skin patch can help by numbing affected areas
  • opioid painkillers, such as tramadol, oxycodone, or morphine
  • steroid injections.

Preventing Shingles Through a Vaccine

Shingles VaccineThe CDC recommends that people age 60 and older get the vaccine.

The best way to protect yourself from shingles and post-herpatic neuralgia may be with the shingles vaccine. The CDC recommends that people age 60 and older get the vaccine, whether or not they recall having had the chickenpox. According to the CDC, studies show that more than 99% of Americans aged 40 and older have had the chickenpox, even if they don’t remember getting it.

If you’ve already had shingles, you can still receive the vaccine to help prevent a recurrence. Doctors typically advise that individuals wait until the shingles rash has disappeared before getting the vaccination.

Certain people should not get the shingles vaccine, including those with a weakened immune system due to:

  • HIV/AIDS or another disease that affects the immune system
  • treatment for another condition with drugs, such as steroids, that affect the immune system
  • cancer treatment, such as radiation or chemotherapy
  • cancer affecting the bone marrow or lymphatic systems, such as leukemia or lymphoma.

According to, the shingles shot is not covered by Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Generally, Medicare prescription drug plans (Part D) cover all commercially available vaccines (such as the shingles vaccine) needed to prevent illness. Contact your Medicare drug plan for more information about coverage. As of the fall of 2017, the full cost of the injection runs just over $200 for patients who have not met their annual deductible, but pricing may vary. The maker of Zostavax, Merck, says the vaccine is covered by many private insurance plans.

In October 2017, the US Food and Drug Administration approved a second shingles vaccine, called Shingrix.

Updated on: 10/17/18
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