When Does Shingles Pain Peak?

Shingles is a viral infection that leads to pain and itching that can last 3 to 5 weeks. The varicella-zoster virus causes both shingles and chickenpox.

Typically, the peak pain of shingles is felt within 4 or 5 days after the first symptoms develop, and it comes along with a blistering rash.

As the blisters scab over, the pain usually starts to disappear. In some cases, the pain does not go away. This is known as a condition called postherpetic neuralgia.

Antiviral medications, especially when started at the first signs of infection, can often shorten the duration and discomfort of shingles.

Pain stages and timeline

There are three main stages of shingles. Their duration is somewhat predictable, but the time spent in each stage along with the symptom severity can vary from person to person.

Prodromal stage

According to a 2017 research article, the prodromal stage occurs before any signs of a rash appear on the skin, and it typically lasts 1 to 5 days.

Some symptoms are felt just under the skin’s surface and can include:

    pain
  • tingling
  • numbness
  • burning
Active stage

In the part of the body where the pain and tingling was felt, a rash develops a few days later during the active stage.

The rash usually shows up on one side of the body and appears as a band on the:

  • torso
    • neck
  • shoulders
  • around one eye

Fluid-filled blisters form within a few days and then crust over within the next week. Expect the rash to clear up entirely within a month or so.

Postherpetic neuralgia

An estimated 20 percent of people with shingles go on to develop postherpetic neuralgia (PHN) — a continuation of symptoms after the rash disappears. Common symptoms include:

  • pain and itching in the area of skin affected by shingles
  • greater sensitivity to pain generally
  • feeling pain from otherwise harmless stimuli, such as a light breeze or a gentle touch

These symptoms often disappear within a year. However, for some people, the nerve hypersensitivity and other symptoms can last for years or a lifetime. These symptoms can lower quality of life.

Symptoms

In addition to pain and a rash, other symptoms of shingles may include:

  • fever
  • headache
  • nausea
  • general flu-like symptoms

For people with PHN, other symptoms can develop, such as:

  • insomnia
  • depression
  • anxiety
  • weight gain

The physical symptoms of PHN may also make it difficult to exercise or perform everyday tasks, such as housework or even getting dressed.

Duration

The duration of shingles pain and other symptoms depends on the person and how soon you begin treatment.

An outbreak can often resolve on its own within a month without treatment, but that timeline often can be reduced to several days if antiviral medications are taken at the earliest signs of a shingles rash.

Post-infection pain

PHN is usually diagnosed if pain, burning, tingling, or other symptoms continue 3 months or so after the rash has disappeared.

It’s not always possible to predict who will develop PHN.

The condition occurs when the nerve fibers involved in the initial shingles outbreak are damaged and cannot communicate properly with the brain. As a result, pain signals can become intensified.

PHN is more common in older adults. People younger than 40 who have shingles are unlikely to experience long lasting symptoms.

Treatments

Like many other viral infections, such as a common cold, shingles has to run its course. However, treatments can often help shorten that course.

The primary treatment for shingles is an antiviral medication. Three common antivirals include:

  • acyclovir
  • valacyclovir
  • famciclovir

If taken soon after a rash develops, antiviral medications can speed up the healing process by a week or more and lessen the severity of symptoms.

Over-the-counter pain relievers may also be helpful during the beginning stages of a shingles outbreak.

Topical treatments may ease itching, such as:

  • a cool, wet compress
  • calamine lotion
  • colloidal oatmeal baths

Depending on your symptoms and their severity, treatment options for PHN can include:

  • antiviral medications
  • antiseizure medications
  • antidepressants
  • opioid pain medications
  • over-the-counter pain relievers

In some cases, patches containing lidocaine and other pain-relieving agents can be worn on the skin to ease symptoms.

When to seek care

Early shingles symptoms, such as pain or flu-like feelings, are not obvious signs of a shingles outbreak.

Once a rash appears, you should see your primary care physician or a dermatologist. A trained eye can often diagnose shingles by visually inspecting the rash.

If you have shingles, you may never experience the extreme pain that can often come with it. You may only feel itching and some minor discomfort.

Even without the painful symptoms of shingles, it’s recommended that you see a healthcare professional and start antiviral treatment within 72 hours of a rash’s appearance.

It’s especially important to seek prompt medical care if a rash forms near one or both eyes. Shingles in the eye may cause permanent vision loss.

The bottom line

About 1 in 3 adults get shingles, and the odds of infection increase with age. Shingles can be an extremely uncomfortable experience, with pain peaking within a week of the first symptoms emerging.

Pain can sometimes linger for months or years. To avoid any of these complications, talk with your doctor about getting a shingles vaccine if you are ages 50 or older of if you have condition that affects your immune system.

If you are affected by shingles, see a medical professional as soon as possible to begin treatment. Treatment can shorten the time you spend in pain and discomfort.

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