Shingles pain: how it starts and what you can do now

Shingles can hit hard — the rash is obvious, but the pain is what most people remember. About 1 in 10 people develop long-lasting nerve pain after shingles. That pain can feel sharp, burning, or like pins and needles, and it often follows the band of skin where the rash appeared.

If you’re dealing with a new shingles rash, acting quickly makes the biggest difference. Antiviral pills (like acyclovir, valacyclovir, or famciclovir) lower virus activity and shorten the episode — but they work best when started within 72 hours of the first blisters. Call your doctor or urgent care as soon as you notice the rash, especially if it’s on your face or near an eye.

Simple steps to reduce pain at home

Start with easy measures that help right away. Apply cool, damp compresses to the blisters for 15–20 minutes to soothe burning. Loose clothing and breathable fabrics reduce irritation. Keep the rash clean and dry to avoid infection. Over-the-counter pain relievers like acetaminophen or ibuprofen can ease general pain, and topical calamine or lidocaine patches can calm local discomfort.

Some people find nerve pain responds poorly to regular painkillers. If your pain is sharp, electric, or wakes you at night, ask your doctor about medications aimed at nerve pain — gabapentin or pregabalin and certain low-dose antidepressants (tricyclics) are commonly used. Topical options like 5% lidocaine patches or high-strength capsaicin creams work well for localized pain and have fewer systemic side effects.

Preventing long-term nerve pain and when to get help

The biggest risk after shingles is postherpetic neuralgia (PHN), a persistent nerve pain that can last months or years. Starting antivirals fast and treating severe pain early reduces that risk. For people over 50, the Shingrix vaccine lowers the chance of getting shingles and PHN by over 90%. If you haven’t had the vaccine yet, talk to your doctor about getting it.

Seek urgent care if the rash is near your eye, you have fever with the rash, the rash spreads widely, or you’re immunocompromised. If pain continues after the rash heals or gets worse despite treatment, ask for a referral to a pain specialist. Treatments like nerve blocks, focused injections, or combination drug therapy can help people who don’t get relief from first-line options.

Shingles pain is rough, but you don’t have to just endure it. Early antiviral treatment, smart pain choices, and prevention with vaccination are the most reliable ways to limit both short-term suffering and long-term nerve damage. Talk to your healthcare provider about the fastest way to start treatment and what pain plan fits your situation.