What is Post-Shingles Pain?

Postherpetic Neuralgia (PHN) is a type of nerve pain that can persist after an outbreak of
shingles (herpes zoster). Shingles occurs when the varicella-zoster virus (the same virus that causes chickenpox) reactivates in the body, typically causing a painful skin rash. Even after the rash heals, nerve damage may lead to ongoing burning, stabbing, or shooting pain in
the affected area. This condition can last for months or even years, and is more common in older adults or
those with weakened immune systems.

What are the symptoms?

You may experience:

  • Persistent burning, stabbing, or shooting pain in the area where the shingles rash appeared
  • Sensitivity to touch (even clothing or a breeze may trigger pain)
  • Numbness or tingling in the skin
  • Sleep disturbance, fatigue, or low mood due to constant pain
  • The pain is typically localised to one side of the body or face

How is it diagnosed?

Diagnosis is clinical and based on:

  • A history of shingles in the affected area
  • The presence of ongoing nerve pain after the rash has healed
  • A physical examination to assess nerve sensitivity, skin changes, and pain response
  • Scans or imaging are not usually needed, unless there are concerns about other underlying conditions

What treatments do we offer?

We take a comprehensive, non-surgical approach to managing post-shingles nerve pain:

1. Peripheral Nerve Blocks

  • We may offer targeted nerve blocks (e.g. intercostal, trigeminal, or cervical blocks) depending on the location of your pain
  • A small amount of local anaesthetic and/or steroid is injected near the affected nerve to help reduce inflammation and pain signals
  • These blocks may provide temporary or longer-term relief and help reduce medication reliance

2. Stellate Ganglion Block (for facial, head, or upper chest pain)

  • For upper body or facial post-shingles pain, we may offer a stellate ganglion block, which targets the sympathetic nervous system and can reduce burning or hypersensitivity

3. Pulsed Radiofrequency Treatment

  • If nerve blocks provide temporary relief, pulsed radiofrequency (RF) may be considered
  • This technique modulates nerve activity without destroying the nerve, offering longer-lasting pain control

4. Medication Optimisation

  • Review and adjustment of your current medications for nerve pain
  • Our clinic does not prescribe opioids or pregabalin, in line with local guidelines
  • We will advise your GP on safe and effective options such as topical agents, tricyclics, or gabapentinoids (as appropriate)

5. Self-Management & Rehabilitation Support

  • Advice on skin care, desensitisation techniques, and gentle movement
  • Support for sleep, mood, and stress management, which can influence nerve pain
  • Where needed, we can suggest psychological or physiotherapy input to support overall wellbeing

What to expect from treatment

  • Pain may gradually reduce over time, but some patients require ongoing pain management strategies
  • Nerve blocks and pulsed RF are minimally invasive and done as day procedures
  • Our goal is to help reduce pain, improve quality of life, and minimise medication burden