When does shingles pain peak?

Shingles is a viral infection that affects your nerves. It causes a painful rash on one side of your body within the first week of symptoms, which develops into itchy blisters. The pain usually peaks within days after you first notice symptoms.

According to the Centers for Disease Control and Prevention (CDC), the blisters typically scab over and clear up within 1 month. For most people, shingles pain typically disappears as the scabs heal.

However, for some people, the pain does not disappear. This is postherpetic neuralgia (PHN), and the older you are at the time of infection, the greater your risk of developing it. According to the CDC, up to 18% of people who have shingles will develop PHN.

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Timeline of shingles

Typically, the shingles rash goes through three or four stages before disappearing. How severe shingles rash pain is and when it peaks varies between individuals.

Pre-eruptive phase

The pre-eruptive shingles phase happens within the first 1 to 5 days of the infection. No rash is visible at this stage, but you will experience symptoms that tell you something is wrong. Pain is typically not the most severe symptom of this phase, and you might experience:

• tingling
• burning sensations on your skin
• patches of numbness
• tiredness
• fever

Eruptive phase

During the eruptive phase, those patches of skin that were previously tingling or numb begin to form a rash. This stage is most likely when your pain will peak, as the rash will begin to blister and form fluid-filled bumps. The pain may worsen before it gets better.

This rash occurs on one side of your body, typically around your waist, shoulders, and neck. In some rare cases, shingles rashes can form around your eye.

Healing phase

The healing phase is usually the final stage. It happens when your fluid-filled blisters dry out and crust over. This happens approximately 7 to 10 days after the rash first appears. This stage is generally when your pain starts to reduce, and your other symptoms are relieved.

The remaining rash should clear up within a couple of weeks.

Chronic phase

Not everyone with a shingles infection experiences the chronic stage. This is when you have PHN, or nerve pain, that continues even after your rash disappears. Around 10% to 18% of people who have had shingles go on to develop PHN, and the risk is higher the older you are.

Most people recover from PHN within 1 year of their first shingles symptoms, but it may last years or even become lifelong.

This stage of shingles can be severely painful, even to the point where a breeze can hurt the affected area. If you experience PHN, this may be the peak of your shingles pain.

Treatments

Typically, a doctor will recommend medications such as antivirals to help treat the infection early on. However, natural remedies you can use at home can help provide relief while these medications start to work.

Medications

If you notice any symptoms of shingles, it is important to speak with a doctor as soon as possible. Many of the following medications are only effective if you take them in the early stages of a shingles infection.

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Natural remedies

Some natural remedies can help soothe shingles pain and itching while you wait for antiviral medications to start working.

These include:

• cool water baths
• oatmeal baths, mixing colloidal oatmeal into lukewarm water
• a cool compress multiple times a day on the rash

Prevention

According to the National Institute of Aging (NIA), even if you’ve previously had a chickenpox infection, the shingles vaccine (Shingrix) is over 90% effective as protection from shingles and complications such as PHN.

The CDC recommends that anyone over 50 years should get the shingles vaccine. Also, anyone over 18 years old who has a compromised immune system due to medications or existing health conditions should try to get the vaccine.

If you previously had the Zostavax vaccine, which is no longer in use, you still need the Shingrix vaccine.

Shingrix involves 2 doses, and you can get it at your local doctor’s office or pharmacy.

Online care for shingles

It’s important to seek treatment for shingles within 3 days of noticing symptoms. Getting the right treatment quickly can help reduce the peak of your pain and prevent PHN. It may also reduce the length of your illness.

Online care services, including Optum Perks Online Care, may make getting treatment easier. With these services, you can submit an online form answering a few questions about your symptoms, and a US-licensed healthcare professional will respond soon after to prescribe a treatment plan.

Summary

Shingles is common but can be uncomfortable, with pain that may linger for months after the initial infection. For most people, the most severe pain from a shingles infection peaks during the first weeks of the infection, during the erupting phase.

To avoid lingering pain from PHN, speak with a doctor about getting the Shringrix vaccine if you are over 50 years old, have a health condition, or take medication that weakens your immune system.

As soon as you notice shingles symptoms, it’s important to speak with a doctor, either in person or through online care services, to receive antiviral medications. These can help prevent pain and long-term complications.

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