11 Smart Remedies to Soothe Shingles Pain
For some of us, shingles can be a rough ride. One in every three people who grew up before a chickenpox vaccine became widely available in 1995 go on to develop this blistering rash later in life as a result of having that infection as a kid. (The varicella zoster virus literally lays dormant in the body for decades before reemerging as shingles.) Most people experience mild symptoms that disappear within a few weeks. But for an unlucky minority, shingles can inflict lasting, painful nerve damage for months. Your guide to finding relief is here.
Why Shingles Can Be Painful
Before we walk you through treatment options, let’s look at why this virus can cause pain. “The varicella zoster [chickenpox] virus develops a latency after chickenpox in these nerves called dorsal root ganglia,” explains Paul Auwaerter, M.D., clinical director of the division of infectious diseases at Johns Hopkins Medicine in Baltimore. “What can happen is, for reasons that aren’t entirely clear, the virus can reactivate within a nerve.” The virus then travels along that pathway to the skin, causing a painful rash. In serious cases, it can lead to lasting nerve damage called postherpetic neuralgia, or PHN.
Try Antivirals for Early Intervention
Let's focus on the painful rash first before diving into nerve pain. If you can treat shingles at the first sign of a rash, antiviral drugs can help mitigate the spread of the virus. “They [are] most effective if used early—best within 72 hours of the onset of symptoms,” Dr. Auwaerter says. The three antivirals used to treat shingles are Famvir (famciclovir), Valtrex (valacyclovir), and Zovirax (acyclovir), and they need to be taken several times per day until your rash subsides. While they don’t treat pain, per se, they can help prevent your rash from getting worse (and pre-empt PHN).
Soothe Blistering Skin With Aluminum Acetate
Now, for some topical relief: This OTC astringent powder is made to calm minor skin irritation such as poison ivy, bug bites, chicken pox, and other itchy rashes. It’s also called Burow’s solution or Domeboro solution, and it can be found at your local pharmacy or online. This won’t work for nerve pain, though, so don’t rely on it for anything more than minor itch relief (which can be painful in itself!). The American Academy of Family Physicians recommends soaking a cool compress in the solution and applying it to the affected area.
Wear Loose Clothing for Added Comfort
Don’t overlook the pain that can come from chafing. Which is why it makes sense to swap form-fitting garb for softer lounge wear to make the healing process more comfortable in those excruciating first few weeks. “Many people wear loose-fitting clothes so it doesn’t irritate the area,” Dr. Auwaerter confirms. Sounds like the perfect excuse to wear sweatpants or even work from home in your PJs, so go ahead and loosen up!
Consider the Benefits of Capsaicin
Another topical treatment is made from chili peppers, and research has shown that it can help with shingles pain reduction. Capsaicin comes in OTC and prescription forms, and it can be applied topically as a cream or by wearing a patch—but it’s tricky to administer properly. A report in Molecules noted that capsaicin can cause a burning sensation on the applied area, especially if applied in frequent dosages. In rare cases, it can also cause blood vessel constrictions. Be sure to get your doctor’s guidance before trying this method on your own.
Soak in a Colloidal Oatmeal Bath
This DYI option hasn’t been tested for shingles specifically but experts say it may provide some skin relief while your rash is still acting up. Colloidal oatmeal is made by grinding oats into a fine powder (you can buy it at the drug store). A study in the Journal of Drugs in Dermatology found that this natural remedy has antioxidant and anti-inflammatory properties which can make it helpful in treating irritated skin. Add colloidal oatmeal to a bath of cool or lukewarm water and soak for about 10 minutes, once per day, for as long as your rash lasts.
Opt for OTC Pain Relievers
Over-the-counter options like Tylenol (acetaminophen) can ease the discomfort of shingles rash and even mild PHN. “At least for early pain, we often use non-steroidal anti-inflammatory drugs [NSAIDs], like ibuprofen or naxopren,” Dr. Auwaerter notes. They’re easy to pick up at any drugstore, but they’re not always ideal for frequent and/or long-term use. NSAIDs can cause stomach irritation and stomach ulcers, and can harm the kidneys unless taken with large volumes of water. If you experience abdominal pain or constipation, ask your doctor to help you find another option.
Steroids Can Sometimes Help
Dr. Auwaerter notes that some older research done in the early 2000s supports the use of the steroid prednisone taken with an antiviral for short-term shingles pain relief, as well as a decreased risk of developing the more serious PHN. (The studies found only a moderate effect on pain reduction.) Steroids may be especially beneficial for people over 50, who are at higher risk for PHN. However, they can increase your risk of immunosuppression over time, so they’re generally used for shingles for just one to two weeks. If you’re trying this approach, work closely with your doctor to manage the appropriate dosing.
Go With Gabapentin for PHN
If you do have the lasting nerve pain of PHN, some doctors will prescribe anti-seizure medications, including Neurontin (gabapentin) or Lyrica (pregabalin). “Even though they were developed as anti-seizure medicines, they can help modulate the nerve pain until the nerves can heal,” Dr. Auwaerter explains. These treatments can reduce pain signaling from the nerves to the brain by calming your neurotransmitters for a short time. They are FDA-approved as an effective treatment for PHN. Like antivirals, they require frequent daily dosing, usually three times per day.
Look for a Lidocaine Patch
Lidocaine is an anesthetic agent that temporarily numbs the area where it's applied, which can help with PHN pain. “With significant postherpetic neuralgia, I find that the topical lidocaine patch is usually the most useful,” says Camille Kotton, M.D., clinical director of transplant and immunocompromised host infectious diseases at Massachusetts General Hospital in Boston. (FYI: Transplant patients are more vulnerable to serious shingles pain—but they’re ineligible to receive the shingles vaccine due to weakened immune systems.) Lidocaine is available as a prescription or OTC, though Dr. Kotton notes it can be difficult to get covered by insurance.
Antidepressants May Offer Surprising Relief
Antidepressants may have been “invented for depression, but they are also known to modulate peripheral nerves,” Dr. Auwaerter says, thereby dulling PHN pain. Your physician may suggest Pamelor or Aventyl (which contain nortriptyline) or Elavil (amitriptyline). Dr. Auwaerter adds that these medications can sometimes cause side effects like fatigue and sluggishness—though PHN patients usually only need a low dose, which is unlikely to cause major adverse effects.
Finally, Use a Cool Water Compresses
Cool water may soothe the burning sensation from both your rash and mild PHN pain. “Depending on the location, you could potentially put a cool pack on it,” Dr. Kotton says, though she notes this won’t help much for severe pain. Soak a cloth in ice water, take it out, and apply directly to the affected area. Ahhhhh. Another soother to consider? This pain very likely won't last forever, even if you have PHN. In the meantime, though, these tips will help you get through the worst of it.
Shingles Treatments: Centers for Disease Control & Prevention. (n.d.) “Treating Shingles.” cdc.gov/shingles/about/treatment.html
PHN Treatments: Korean Journal of Pain. (2018.) “Modalities in managing postherpetic neuralgia.” ncbi.nlm.nih.gov/pmc/articles/PMC6177534/
Steroids: American Academy of Family Physicians. (2000.) “Management of Herpes Zoster (Shingles) and Postherpetic Neuralgia.” aafp.org/afp/2000/0415/p2437.html
Gabapentin: Clinical Interventions in Aging. (2012.) “Gabapentin for once-daily treatment of post-herpetic neuralgia: a review.” ncbi.nlm.nih.gov/pmc/articles/PMC3410680/
Transplant Patients: University of Wisconsin Health. (n.d.) “Infection and the Transplant Patient.” uwhealth.org/healthfacts/transplant/6791.pdf
Capsaicin: Frontiers in Pharmacology. (2016.) “The Effectiveness and Safety of Topical Capsaicin in Postherpetic Neuralgia: A Systematic Review and Meta-analysis.” ncbi.nlm.nih.gov/pmc/articles/PMC5222862/
Capsaicin Adverse Effects: Molecules. (2016.) “Harnessing the Therapeutic Potential of Capsaicin and Its Analogues in Pain and Other Diseases.” ncbi.nlm.nih.gov/pmc/articles/PMC6272969/
NSAIDs and Gut Health: Clinical Microbiology and Infection. (2015.) “The Influence of Nonsteroidal Anti-Inflammatory Drugs on the Gut Microbiome.” ncbi.nlm.nih.gov/pmc/articles/PMC4754147/
Opioids for PHN: Neurology. (2016.) “The Use of Opioids in Patients with Postherpetic Neuralgia (PHN) Treated with Gabapentin.” n.neurology.org/content/78/1_Supplement/P04.169
More Treatments: American Academy of Family Physicians. (2000.) “Shingles.” aafp.org/afp/2000/0415/p2447.html