Nerve pain

Shingles and postherpetic neuralgia treatment in Singapore

Name: Shingles and postherpetic neuralgia treatment in Singapore
Creator: Dr Christopher Liu

Shingles is a painful blistering rash caused by the chickenpox virus waking up again. For most people the pain settles as the rash heals, but for some it lingers for months as postherpetic neuralgia. Early treatment helps, and there are good options if pain does continue.

At a glance

Common signsA burning, tingling or shooting pain on one side of the body or face, followed days later by a blistering rash in a band.

See a specialist ifThe pain stays after the rash heals, is severe, or keeps you awake, and ordinary painkillers are not enough.

What may helpAntiviral tablets started early for shingles, nerve pain medicines and patches for lingering pain, and nerve blocks or other procedures when needed.

Seek urgent care forA rash in or near the eye, new hearing loss or facial weakness, a widespread rash, or shingles when your immunity is lowered.

Written and reviewed by Dr Christopher Liu, Pain PhysicianLast reviewed: 27 October 2026About Dr Liu

What is shingles?

Shingles (herpes zoster) is caused by the varicella-zoster virus, the same virus that causes chickenpox. After chickenpox the virus stays dormant in nerve roots. Years later, often with ageing, illness or lowered immunity, it can wake up and travel along the nerve to the skin.¹

This causes pain and then a rash of blisters, usually in a band on one side of the chest, abdomen, face or another part of the body. The blisters crust over in about a week or two. The rash itself usually clears in a few weeks.

Symptoms and diagnosis

Shingles often begins with burning, tingling, itching or sharp pain in a patch of skin, sometimes with tiredness, a mild fever or headache. The rash appears one to several days later.

The diagnosis is usually made from the typical rash and its pattern. A swab from a blister can be tested if the picture is unclear. If you think you may have shingles, see a doctor promptly, because treatment works best when started early.

Treating shingles early

Antiviral tablets such as aciclovir, valaciclovir or famciclovir are most useful when started within about 72 hours of the rash appearing. They can shorten the illness, ease the acute pain and lower the chance of long-term nerve pain, so starting early matters.¹

Pain control matters too. Simple painkillers may be enough for mild pain, while stronger pain needs medicines for nerve pain. Keep the rash clean and covered, and avoid contact with babies, pregnant women who have not had chickenpox, and people with weak immunity until the blisters have crusted over.

Seek urgent medical care if you have shingles with:

a rash or blisters on or near the eye, or on the tip of the nose
new hearing loss, ringing in the ears, dizziness or weakness of one side of the face
a rash that is widespread or spreading fast, or you have a weakened immune system
fever, confusion, a severe headache or a stiff neck, or skin that is turning red, hot and swollen

See a doctor the same day, or go to the nearest emergency department.

What is postherpetic neuralgia?

Postherpetic neuralgia (PHN) is nerve pain that continues in the area of the rash after it has healed, usually defined as pain lasting three months or more. It is more likely with increasing age, a severe rash and severe pain at the start.¹

It can feel burning, stabbing or throbbing, and the skin may be so sensitive that clothing or a light breeze hurts. It can disturb sleep, mood and daily activity.

Medicines for PHN

Medicines made for nerve pain are the foundation of treatment. Examples of nerve pain stabilisers include gabapentin, pregabalin and low-dose tricyclic medicines such as amitriptyline or nortriptyline, as first choices.

Lidocaine patches are also helpful if the painful area is small. These treatments take time, are started low and increased slowly, and may cause drowsiness or dizziness, so we tailor them to your age and other medicines.

When pain continues

If pain persists despite medicines, or side effects limit what you can take, a specialist may offer:

nerve blocks, which place local anaesthetic (sometimes with a steroid) near the affected nerves, guided by ultrasound or X-ray
pulsed radiofrequency treatment of the nerves involved
spinal cord stimulation, a small implanted device, for severe pain that has not responded to other treatment

Gentle, graded exposure of the sensitive skin to soft touch can also reduce hypersensitivity over time. We explain the possible benefits and risks of each option before you decide.

Preventing shingles

The recombinant zoster vaccine (Shingrix) can greatly reduce the chance of shingles and of PHN. In many countries it is recommended for adults from 50 years of age and for younger adults with weakened immunity. It is available in Singapore, so ask your own doctor whether and when it suits you.

You can have the vaccine even if you have had shingles before, once the illness has settled.

Living with the pain

PHN often improves slowly over months, though some people have pain for longer. While it does, it helps to keep gently active, protect your sleep, wear soft loose clothing, and speak to someone if low mood or worry is building. You do not have to put up with the pain: if it is not controlled, a review of your treatment can make a real difference.

Dr Christopher Liu, Pain Physician

MOH accredited Pain Specialist and Medical Director of Alleviate Pain Clinic at Farrer Park Hospital. He completed an interventional pain fellowship at the University Health Network in Toronto and was previously a Senior Consultant in Pain Medicine at Singapore General Hospital.

Related conditions

Nerve painOverview of neuropathic pain Trigeminal neuralgiaSudden facial nerve pain Diabetic neuropathyNerve damage from diabetes

References

Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44(Suppl 1):S1–S26. doi:10.1086/510206
Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173. doi:10.1016/S1474-4422(14)70251-0

This page gives general information and is not a substitute for medical advice. Please see a doctor about your own symptoms and treatment options.

Common questions

How long does shingles pain last?

The rash usually heals within two to four weeks, and for most people the pain fades with it. If pain remains after about three months, it is called postherpetic neuralgia, and it is worth seeing a pain specialist.

Is shingles contagious?

You cannot give someone shingles, but you can pass on the chickenpox virus through contact with fluid from the blisters. This can cause chickenpox in someone who has never had it or been vaccinated. Cover the rash until the blisters have crusted over.

Can I get shingles more than once?

Yes, although it is uncommon. Vaccination lowers the chance of getting shingles again.

Do I still need treatment if I am past the 72-hour mark?

Yes. Antivirals are most useful early, but your doctor may still advise them, particularly if you have new blisters, eye involvement or weak immunity. Pain treatment is helpful at any stage.

Will PHN go away?

Many people improve gradually over months, and treatment can make the pain much more manageable. A small number have pain for longer, which is why it is worth getting specialist help rather than waiting.