Shingles Back Pain: Symptoms, Causes, And Treatment

As an adult, the infections that we had in childhood can sometimes rear our heads again as we grow older. Shingles are one such condition. As with many activities and health issues that affect the back as we age, shingles back pain is a common challenge among those who develop the condition.

What are shingles, and how can they be diagnosed?

Shingle is a condition caused by the virus that causes chickenpox. This virus is called 'varicella-zoster.

Once infected, the varicella-zoster virus never leaves your body but instead stays inactive in nerve cells, especially those that branch out from your spine. This is why shingles and back pain often go hand in hand. It's also why anyone who has had chickenpox in the past, which is 99% of people in the US who were born before 1980, can contract shingles.¹

In adulthood, the virus is reactivated in about one in three people and travels along the nerves to infect the skin. It's marked by a rash that often appears on the chest, abdomen, or lower back, although it may appear anywhere on the body, including the face.²

What does an early case of shingles look like?

You'll first notice some nerve tingling or pain sensations when shingles is in its early stage. These symptoms can be accompanied by itching or numbness on one side of your body.

Phases of shingles

There are three phases of shingles:

• Pre-eruptive phase: This is the early stage of shingles, marked by burning or tingling skin sensations. It begins around 48 hours before you notice skin rashes or blisters.

• Acute eruptive phase: This is the active stage of shingles, during which your pain will intensify, and you'll first notice flat, reddish discolorations of the skin that may change into fluid-filled blisters, similar to chickenpox. These marks may form a band, often on one side of the body. They will dry and crust over after about 7–10 days, and the phase typically lasts 2–4 weeks while the skin heals completely.

• Chronic phase: About 10–18% of people with shingles will develop long-term pain from the reactivation of the varicella-zoster virus. This is known as postherpetic neuralgia (PHN). It may last a year or more and be accompanied by burning or tingling of the nerves (known as paresthesia) and crawling, stinging, or other uncomfortable skin sensations (known as dysesthesia).³ ⁴ ⁵

How are shingles diagnosed?

Your doctor begins with a physical examination to check the appearance of your skin rash and discuss your symptoms with you.

Chickenpox test

If your doctor suspects that you have shingles, an antibody test can be done on people who aren't sure if they've had chickenpox in the past. Your doctor will draw blood and test it for the IgM antibody. If this antibody is present, this means you've had chickenpox in the past, and therefore you may have shingles.

Blister tests

Several methods may be used to test the fluid within your skin blisters or eye fluid for outbreaks near your cornea to confirm if the outbreak is shingles. The three main types of blister tests are:

• Polymerase chain reaction (PCR) test: This is the gold standard shingles test that checks the fluid for DNA unique to the varicella-zoster virus.

• Direct fluorescent antibody (DFA) test: Though less sensitive than PCR tests, DFA tests are sometimes used to diagnose shingles that affect the eye or provide a quick diagnosis. A follow-up PCR test is often conducted to confirm the diagnosis.

• Tzanck smear: Though this test is older and less accurate than PCR and DFA tests, it is sometimes used for quick, inexpensive diagnosis of shingles, and just like with DFA tests, it's then confirmed with a PCR test if it comes back positive.

Symptoms of shingles

The most common symptoms of shingles include:

• Tingling or burning sensations of the skin, especially before an outbreak occurs

• Headaches and nausea

• Fever and chills

• A flat, reddish rash on one side of the face, neck, chest, abdomen, or back, which may form a band around your torso, back, or other areas

• The development of fluid-filled blisters similar to chickenpox after the initial rash occurs

• Pain that intensifies during the outbreak phase

• Itching and stinging sensations on the skin

Other symptoms may include:

• Infection that spreads to the eye, known as ophthalmic shingles, which may cause blindness if left untreated

• Infections that spread to the ears may cause hearing loss

• Infections that spread to the face may cause temporary paralysis in that region

Can shingles cause back pain?

Yes, the virus often settles in nerve "roots" that extend out from the spine, and therefore you may experience back pain, even if the outbreak doesn't occur on your back.

Shingles on the lower back

Since the torso and waist areas are the most common regions where shingles outbreaks occur, lower back pain is a common symptom of the condition.

What are the risk factors?

A weakened immune system is one of the main triggers for a shingles outbreak. Older people are also at a higher risk for the condition, especially those aged 50 and older. In fact, people aged 60 and older account for almost half of all shingles cases in the US, and the risk for serious complications rises in this age group.

Likewise, older people are more at risk than younger people for developing postherpetic neuralgia (PHN), or chronic pain, after having a shingles outbreak.  

How to ease severe back pain from shingles

Managing your severe back pain from shingles is a multi-treatment strategy that includes antiviral medications, pain relievers, and at-home remedies.

Antiviral medications

The three most common antiviral medications for shingles all help reduce your risk of developing PHN, particularly if you begin taking them within the first few days of symptom appearance. They are:

• Acyclovir

• Valacyclovir

• Famciclovir

These medications are aimed at helping you clear up the outbreak faster. Although people taking antiviral medications don't typically experience side effects, they may cause diarrhea, nausea, headaches, stomach aches, or vomiting in a minority of cases.  

Pain relief remedies

Drugs called gabapentinoids and tricyclic antidepressants are some of the most commonly prescribed pain relievers for people who experience pain both during and after their shingles infection has healed on the skin.

More recently, thanks to clinical trials, a delivery method of the drug gabapentin (the generic form of Neurontin) was approved by the FDA. It allows for timed release of this pain relief medicine. The treatment is called 'gastroretentive gabapentin,' and has been shown to provide "significant" pain relief for people with PHN. It also has been shown to help with sleep interruptions caused by PHN (such as shingles back pain at night), which is important because proper rest can help with pain management.

Topical lidocaine patches and creams are also prescribed to help numb back pain. In addition, a natural ingredient in chili peppers called 'capsaicin' has been shown to reduce pain when administered in high doses. In fact, capsaicin 8% patches have been shown to be effective in reducing PHN pain after just 60 minutes.⁶

These patches are available by prescription, and some can even be purchased over the counter.

At-home care

Some natural ways to help ease your severe back pain from shingles. These include:

• Getting extra rest

• Looking for over-the-counter topical creams that contain capsaicin in them to help decrease pain symptoms

• Practicing proper dietary habits for pain, including eating foods that reduce inflammation to help better control nerve pain

• Engaging in stress-relieving activities, such as nature walks and mindfulness meditation, which has been shown to help with PHN of the back

• Applying cold packs wrapped in a towel or cloth to your back

Can you prevent shingles?

According to the National Institutes of Health (NIH), the vaccine known as 'Shingrix,' given in two doses, is 90% effective at preventing shingles. For people ages 50–69 with healthy immune systems, the Centers for Disease Control (CDC) states Shingrix is actually 97% effective. Even in adults with compromised (weak) immune systems, the vaccine is 68–91% effective in preventing the condition. It is also 89–91% effective at preventing PHN (post-infection pain) for adults ages 50 and older.⁷

The NIH recommends taking Shingrix if:

• You're unsure if you've had chickenpox

• You had the older (less effective) Zostavax vaccine for shingles

• You have had chickenpox or the chickenpox vaccine

• You have already had shingles

When is the right time to visit a doctor?

Visit your doctor if you suspect you may have shingles. Taking the medication within three days of the first symptoms is the most effective way to treat this condition.

Anyone with ongoing pain after a shingles outbreak should also visit a doctor to discuss long-term treatment options.

Four fast facts about shingles back pain

Can shingles go up your spine?

Although rare, there are cases of shingles traveling up the spine and causing meningitis, stroke, and other serious health risks.

Can shingles make your back hurt?

Yes, because shingles clusters often occur in nerves that branch off from the spine, shingles back pain is common.

What helps with back pain from shingles?

Start on antiviral medications as soon as you notice symptoms of shingles to help reduce your risk of developing shingles back pain. Pain medications such as tricyclic antidepressants and 'gastroretentive gabapentin' are prescribed for pain caused by outbreaks and  PHN. Capsaicin 8% patches, cold compresses, stress-reducing activities, extra sleep, proper diet, and over-the-counter lidocaine numbing creams can also help you manage these symptoms.

How long does back pain last with shingles?

For 82–90% of people who don't experience the chronic phase of shingles, back pain can last 2–4 weeks. Those who do develop PHN could have back pain that lasts 12 months or longer.

The lowdown

Anyone infected with the varicella-zoster virus that causes chickenpox can develop shingles. Since the virus often spreads out from spinal nerve "roots," you may also experience back pain even if your outbreak occurred in a different area of the body. 

Shingle symptoms usually heal within 2–4 weeks with proper treatment, although 10–18% of those infected develop a chronic condition called postherpetic neuralgia (also known as long-term nerve pain or PHN) that can last a year or longer.

Shingles are most likely to occur in people older than 50 and have lowered immunity. Direct contact with someone who has an outbreak is also a risk factor if you have lowered immunity and already have had chickenpox. 

The vaccine Shingrix is proven to be 90% effective in reducing the risk of developing shingles and PHN, especially in people over 50. It's also 89–91% effective at preventing PHN for adults aged 50 and older.

Early antiviral medication can lower your risk of getting PHN and the back pain it may cause when an outbreak of shingles does occur. But even without getting PHN, shingles pain often worsens during the acute eruptive phase. Because of this, tricyclic antidepressants and gabapentinoids, two classes of pain medications, are frequently recommended.

Numbing medications like lidocaine and capsaicin 8%  patches may also be prescribed or obtained over the counter. Shingles back pain can be treated at home with cold compresses, stress-relieving activities, a healthy diet, more sleep, and over-the-counter pain creams. If PHN arises, these treatments are also an option. Most shingles cases resolve in a month with proper treatment.