Patient information from BMJ

Shingles: what are the treatment options?

Last published:Aug 16, 2021

Anyone who has had chickenpox can get shingles in later life. Shingles can be very painful but there are good treatments that can shorten an attack and help prevent long-lasting problems. There are also vaccines to help prevent shingles.

What treatments work to prevent shingles?

Two vaccines are available to help protect older people from getting shingles. The one you are offered might depend on what is available and preferred by your health authority.

• Zostavax is a vaccine given as a single injection. It is suitable for most people, but not for pregnant women, people who have problems that affect their immune system, and children.

• Shingrix is given as two injections, a few months apart. It seems to be more effective than Zostavax, especially in older people. But it seems more likely to cause irritation after you have the injection.

Both vaccines reduce your chance of getting shingles. If you do get shingles after having the vaccine, the vaccine can help:

• make the symptoms less severe, and

• reduce the chance of long-term pain.

What treatments work to treat shingles?

Shingles is caused by the same virus that causes chickenpox. It’s called the varicella zoster virus.

Once you’ve had chickenpox the virus lives in your nerve cells. Usually it stays in your nerve cells for many years and doesn’t cause any problems. Your immune system keeps it in check. 

But as you get older, or if your immune system is weak, the virus may ‘wake up’ and start reproducing in your nerve cells. The virus then travels to the nerve endings in your skin. This can cause a painful rash and make you feel ill.

Treatment during an attack of shingles can help ease your symptoms and reduce your chances of getting more serious problems, such as long-lasting pain. If you do get long-lasting pain there are treatments that can help. 

Things you can do for yourself

Shingles can be very uncomfortable. There are some things you can try to make yourself feel better.

• Take over-the-counter painkillers, like paracetamol. You can also use calamine lotion to soothe itching and pain.

• Wear loose clothing that is unlikely to irritate your skin.

• Keep the rash clean and dry.

• Protect the rash with a loose, non-stick, sterile dressing.

• Cool the rash by using an ice pack or taking a cool bath.

If you still have pain despite taking over-the-counter painkillers, ask your pharmacist or doctor for help. They may be able to recommend a stronger painkiller.

Treatments for a shingles attack

Taking antiviral tablets when you have an attack of shingles means your pain is likely to go away sooner. Your pain may also be milder and the rash may clear up more quickly. Antivirals work by stopping the virus from reproducing. 

If you have the shingles rash on your face, taking antiviral tablets can reduce your chances of getting eye problems from shingles. 

Like all medications, antivirals can cause side effects in some people. These can include a headache or feeling sick. But these side effects are not usually serious.

If you get long-lasting pain

Lasting pain after shingles is called post-herpetic neuralgia. It continues after your rash has cleared up, sometimes for months or longer. Treatments can help you feel better.

If your pain is mild, taking over-the-counter painkillers, such as paracetamol or ibuprofen, can help. Some people also find that using a cream containing the chilli-pepper extract capsaicin helps their pain.

Your doctor might also recommend taking a weak opioid painkiller, such as codeine.

If your pain is more severe your doctor might prescribe a stronger opioid medicine, such as tramadol. But your doctor will probably prescribe a low dose, as tramadol can be addictive. If you are concerned about becoming addicted to opioid painkillers, talk to your doctor.

Tramadol can also cause other side effects, including constipation, drowsiness, and nausea.

If strong painkillers don't help enough, your doctor may prescribe a certain type of antidepressant, called a trycyclic. These drugs are usually used to treat depression. But at a low dose they can help reduce nerve pain.

You may need to take a tricyclic for several weeks before it starts to work. Possible side effects of tricyclics can include feeling tired, having stomach pain, and feeling restless. 

Another option for severe pain is a drug called an anticonvulsant. These drugs are usually used to treat epilepsy but they can also help with nerve pain.

Side effects of anticonvulsants can include feeling dizzy, feeling sleepy, putting on weight, and getting constipated.

For more background information on shingles see our leaflet Shingles: what is it?