When Does Shingles Pain Peak And How Long It Lasts?

Shingles occurs when the varicella-zoster virus (the virus that causes chickenpox and shingles) is reactivated.

The condition is also referred to as herpes zoster.

Shingles pain can be debilitating and can interrupt your ability to perform day-to-day tasks. Understandably, people experiencing an outbreak may wonder when shingles pain peaks and how long it lasts.

Shingles symptoms

Shingles symptoms include:¹

• Tingling or burning pain (during the prodromal stage)

• Constant or intermittent pain that intensifies during the acute phase

• A flat or bumpy discolored rash that turns into blisters

• Fever

• Headache

• Nausea

• Chills

Stages of shingles

A shingles outbreak has three key stages, each with its own symptoms. Shingles pain tends to manifest in different ways during each stage, although you may experience some overlap.

Prodromal stage

The prodromal stage is when you’ll first notice that your skin is tingling or burning. These symptoms will usually occur on one side of the body. The rash won’t have appeared yet.

Other symptoms of the prodromal stage can include a fever, a general feeling of discomfort or fatigue, and the onset of pain. The pain can feel like prickling or pins and needles. Itching or numbness in the spot where the rash will soon appear is also common.²

This stage typically lasts for 1–5 days.³

Active stage (also called the acute eruptive stage)

The active stage starts with tiny bumps that last for a few days. You will then develop fluid-filled blisters.

Since shingles is caused by the same virus as chickenpox, these blisters are a reactivation of the chickenpox virus.

The timeline is different for everyone, but your blisters will typically burst and start again after around 7–10 days.

Shingles is most contagious in the active stage — specifically when your blisters are still filled with fluid or have burst and are discharging fluid. Anyone who has not had chickenpox (or been vaccinated for chickenpox) who comes into direct contact with the blister fluid may become infected with the varicella-zoster virus.

Chronic stage

Not everyone who contracts the shingles virus experiences the chronic stage, but it’s important to note that chronic pain may last months or years.⁴

You are experiencing postherpetic neuralgia (PHN) if the pain associated with your shingles persists for more than four weeks.

Recovery

Your blisters should begin scabbing over after 7–10 days. This stage will last a few weeks and then your scabs will disappear.⁵ Pain may continue during recovery, although most people find it becomes less intense during this time.

In total, a shingles outbreak typically lasts for 3–5 weeks.⁶

When does shingles pain peak?

The active stage is considered the most painful. Symptoms intensify as this stage progresses.⁷

How long does shingles pain last?

In over 80% of people, shingles pain will clear up within 3–5 weeks of when the first symptoms appeared.

Those who develop PHN may have chronic pain that lasts for up to 12 months or more.⁸

Is shingles pain constant or intermittent?

Shingles pain during an outbreak can be constant or intermittent, with a burning or tingling sensation ranging from mild to severe. Stabbing pain may also occur intermittently.

PHN pain can also be constant or intermittent and generally occurs in the region where you had the shingles outbreak.

Why is my shingles pain getting worse?

Shingles pain gets worse during the active phase and eases as you move into the recovery phase.

Pain after recovery from shingles

Although most people only experience shingles pain through to the end of the recovery phase, some people have chronic pain after the outbreak. This is known as postherpetic neuralgia.

Postherpetic neuralgia

The Centers for Disease Control (CDC) estimate that among those who have a shingles outbreak, 10–18% will develop PHN.⁹ It’s considered the most common shingles complication and often occurs where you had a rash or blisters.

Since the varicella-zoster virus travels along nerve cell fibers to your skin when an outbreak occurs, you may also experience pain anywhere along the route the virus traveled.¹⁰

PHN develops when nerves are damaged or inflamed by the virus.¹¹ Left untreated, PHN may lead to:

• Depression

• Sleep disturbance

• Disability or limited ability to function

Other shingles complications

People who experience pain during a shingles outbreak that lasts 30 days or more have a higher risk of developing recurring shingles.¹² This means experiencing more than one outbreak in your lifetime.

Other complications of shingles may include:¹³ ¹⁴

• Vision loss

• Meningitis

• Bacterial infections in the blisters

• Postherpetic itch

• Increased risk for stroke and heart attack¹⁵

• Ramsay Hunt syndrome¹⁶

When to seek medical help for shingles

Contact your doctor immediately when you notice shingles symptoms. Medications are most effective when taken within three days.

Seek emergency treatment if your shingles pain is debilitating and interfering with your ability to function. The pain itself isn’t life-threatening, but there may be an underlying condition that needs to be addressed.

Untreated shingles in your eyes, ears, or mouth can lead to vision and hearing loss. Internal shingles can also negatively affect your health. Seek immediate medical attention if you experience any symptoms you believe are life-threatening.

How is shingles pain treated?

Antiviral medications used to treat the symptoms of a shingles outbreak include the following:¹⁷

• Aciclovir

• Valaciclovir

• Famciclovir

These are typically prescribed for 7–10 days to help reduce symptom severity and the length of the outbreak.

Valaciclovir may be particularly helpful when shingles pain peaks. It has been shown to stop pain faster than acyclovir, both during and after an outbreak.¹⁸

Pain medications like the anticonvulsant gabapentin and tricyclic antidepressants can also be prescribed for shingles nerve pain. Topical treatments such as lidocaine may also provide relief. Additionally, your doctor may recommend over-the-counter anti-inflammatory drugs like ibuprofen.

Tricyclic antidepressants may also help those who experience depression as a result of pain.

What do you do when shingles pain is unbearable?

Lidocaine creams, gels, or sprays act as a kind of local anesthetic to help numb the area where you are experiencing extreme pain. Some can be purchased over the counter, while others must be prescribed by your doctor.

Similarly, capsaicin, an ingredient in chili peppers, can be used to achieve brief initial sensitization followed by prolonged desensitization of the local pain nerves in adults with chronic neuropathic pain.¹⁹ It’s also available in topical creams and patches.

You might find that applying a cold compress to the area where the outbreak occurred helps temporarily numb your nerve pain.

If your pain continues to overwhelm you, contact your doctor. They may need to alter your pain medication, your dosage, or both.

Why is shingles pain worse at night?

One of the benefits of a good night’s rest is that it helps heal your body. However, pain makes it more difficult for your nervous system to calm down before bedtime and in between sleep cycles.

In this way, shingles pain can interrupt your normal sleep pattern. A 2016 study suggests that these interruptions may increase pain or reduce your tolerance to it.²⁰

Another study included data from over 10,000 people and found that sleep issues were “significantly” associated with decreased pain tolerance.²¹

Even if you don’t experience many sleep interruptions, certain hormones that act as anti-inflammatory agents (like cortisol) decrease during the nighttime.²² Inflammation increases in turn, and so does neuropathic pain as a result.²³ ²⁴

Here are a few other reasons why your shingles pain may be worse at night:

• Your sleep position may be putting added pressure on the painful area

• You don’t have the benefit of distractions (like working or driving) to keep your mind off the discomfort

• Your pain management medications may be wearing off too quickly at night

What helps shingles pain at night?

Gastroretentive gabapentin is a time-released version of gabapentin. It was recently approved by the US Food and Drug Administration (FDA) to help treat PHN pain.²⁵ Participants in a 2016 study experienced a 30% or greater reduction in PHN-related sleep interruptions after taking the medication.²⁶

You can also help reduce shingles pain at night by staying on schedule with your prescribed pain medications. Applying lidocaine or capsaicin topicals to the affected area right before you go to sleep and again if you wake up with pain can also help.

Who is at risk of developing shingles?

Anyone who has had chickenpox is infected with the shingles virus and at risk for an outbreak. The individual risk for developing shingles is estimated to be 30% over the course of a lifetime.²⁷

A weakened immune system and increasing age are two of the biggest risk factors for developing shingles. The risk for shingles and postherpetic pain both increase significantly after the age of 50.

Shingles cases occur more often in women than men.²⁸ The condition is at least 50% less prevalent in black populations than in white populations.²⁹

Can you prevent shingles?

Having the Shingrix vaccine is one of the most effective ways to help prevent shingles.

The vaccine has been shown to be 90% effective in preventing shingles and PHN pain.³⁰ For adults aged 50–69 with a healthy immune system, it’s 97% effective at preventing shingles.³¹

The Shingrix vaccine is recommended whether or not you have had chickenpox or a shingles outbreak in the past.

Since a key risk factor for developing shingles is a weak immune system, keeping your immune system strong with proper diet, exercise, and lifestyle practices can also help prevent an outbreak.

The lowdown

Shingles pain peaks during the active phase when a rash and blisters develop on your skin.

Fewer than 20% of people also experience long-term shingles pain known as postherpetic pain. This typically lasts 3–6 months after the recovery phase, although it can last for up to a year or more.

Certain hormone fluctuations in the body — and the pain itself — may cause shingles pain to worsen at night. Your doctor may prescribe a time-release form of gabapentin (a pain relief medication) to help with pain at night.

Antiviral medications and tricyclic depressants are also prescribed to reduce symptom severity and the length of the outbreak.

Shingles can be prevented with the Shingrix vaccine. This vaccine has been shown to be 90% effective at preventing both shingles and PHN pain.