Shingles

We use the following pain treatments for Shingles:

  • Intercostal Nerve Block
  • Stellate Ganglion Block
  • Antiviral medication (acyclovir, valacyclovir, famciclovir)
  • Steroids (prednisone)
  • Opioid medication (narcotics)
  • Tricyclic antidepressants (amitriptyline [Elavil] and nortriptyline [Pamelor])

Shingles (herpes zoster) is a viral infection of the dorsal nerve root ganglia. It causes pain, frequently intense, and often a rash on one side of the body. The rash appears in a band or a strip, often starting in the middle of the back and wrapping around to the breast, but it can occur on any part of the body, such as the forehead and abdomen. Shingles is most common in older adults and people who have weak immune systems because of stress (illness in the family, emotional distress), injury, disease (cancer, AIDS), or are taking certain medicines that lower the immune system.

Shingles occurs when the virus (varicella zoster) that causes chickenpox starts up again in the body. After the chickenpox heals, the virus moves from the skin along the nerves and into the dorsal root ganglia, a part of the nervous system which lies next to the spinal cord. The virus may stay there for many years in an inactive state (dormant). In some people, it stays dormant forever. In others, the virus is reactivated when disease, stress, or aging weakens the immune system. The reactivated virus begins to multiply within the dorsal root ganglia, which causes damage and swelling to this area of the nerve. This damage to the nerve causes the first pains of shingles. The virus then moves along the nerve to the skin, damaging the nerve and causing swelling as it goes. When the virus finally reaches the skin, it causes the shingles rash.Fortunately, in most cases, the pain of shingles gradually disappears over several weeks or months. Most people with shingles will have no or very little pain one year after the rash.

Postherapetic Neuralgia


If the pain from shingles does not go away (even though the rash often has resolved), it is called postherpetic neuralgia (PHN). Only a small number (10-20%) of people with shingles develop PHN. The pain of postherpetic neuralgia can last up to 3 years.

We use the following pain treatments for PHN:

  • Topical lidocaine patch
  • Anticonvulsants (Neurontin, Tegretol)
  • Tricyclic antidepressants (amitriptyline [Elavil], nortriptyline [Pamelor], desipramine, doxepin)
  • Opioid medication (narcotics)
  • Nerve blocks (TENS, sympathetic block, intercostal nerve block)
  • Nondrug therapy (rehabilitation therapies and psychological therapies [relaxation therapy and biofeedback])

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