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Shingles Pain & Postherpetic Neuralgia: who to see and what helps

Shingles Pain & Postherpetic Neuralgia · Kitchener, Waterloo & Cambridge

Shingles is a painful, blistering rash on one side of the body, caused by the chickenpox virus becoming active again. See a physician or nurse practitioner as soon as you suspect it: antiviral medicine works best when it is started within three days of the rash appearing, and a rash on the face near an eye needs medical care the same day. At CARESPACE that visit is with a Nurse Practitioner. For the nerve pain that can linger afterwards, called postherpetic neuralgia, treatment is mostly medicine, and what our other services add is limited.

What shingles and postherpetic neuralgia are

After chickenpox the varicella-zoster virus stays in the body, and years later it can reactivate as shingles (herpes zoster). The Public Health Agency of Canada estimates that nearly 1 in 3 Canadians develops shingles in their lifetime, with about 130,000 new cases a year, more than two-thirds of them in people over 50.

Postherpetic neuralgia is the most frequent complication: nerve pain that lasts more than 90 days from the start of the rash. The same agency counts about 17,000 cases a year in Canada.

Symptoms of shingles

  • Tingling, itching or pain in one area of skin, sometimes with a headache or feeling unwell, before any rash shows
  • A rash a few days later, on one side of the body only and often in a strip, most often on the chest or abdomen but possibly on the face, eyes or genitals
  • Blisters that fill with fluid, then dry out and crust over
  • A rash that can be harder to see on brown and black skin
  • Occasionally, the pain without any rash
  • Afterwards, for some people: pain or sensitivity to touch where the rash was, lasting months or longer

A rash on both sides of the body is unlikely to be shingles.

Who gets shingles

Anyone who has had chickenpox can. Most people who do are over 50 or have a weakened immune system, for example from cancer treatment, steroid or transplant medicines, or HIV. Shingles and its complications become more common and more severe with age.

You cannot catch shingles from someone who has it. A person who has never had chickenpox or the chickenpox vaccine can catch chickenpox from direct contact with the rash, until every blister has crusted over.

How shingles is diagnosed

Usually by a physician or nurse practitioner looking at the rash. If the diagnosis is not clear, cells from a blister can be tested.

When shingles is urgent

Get medical care the same day, from a physician, a nurse practitioner, an urgent care clinic or an emergency department, if you have a rash or blisters on your face, especially near an eye or on the tip of your nose, or any change in your vision. Shingles that involves the eye can cause scarring and blindness, and early treatment helps prevent lasting damage. UK guidance asks for the same urgency when someone who may have shingles is pregnant, has a severely weakened immune system (from chemotherapy, for example), is 17 or younger, or is breastfeeding with the rash on a breast.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Everyone else: see a physician or nurse practitioner within three days of the rash appearing, and sooner if you can. Do not wait for a convenient appointment. A walk-in clinic counts.

Go back if the rash looks infected, or if pain is still there more than a month after the skin has healed.

What the evidence says about treating shingles and the pain after it

  • What we read. The Public Health Agency of Canada, Alberta’s and the UK’s public health services, Ontario sources on who can prescribe, guidance on nerve pain from the UK (NICE) and the Canadian Pain Society, and three systematic reviews.
  • Antiviral medicine, started early. It reduces how severe shingles is and how long it lasts, and it works best in the first three days after the rash appears. In UK practice a mild rash may need no antiviral; it is offered for moderate or severe pain or rash, a weakened immune system, or a rash beyond the chest, abdomen and back.
  • In Ontario the prescription comes from a physician or nurse practitioner. The NHS sends adults with shingles to a pharmacist. In Ontario, prescribing for shingles is not yet within pharmacists’ scope, according to the Ontario College of Pharmacists in October 2026; they can advise on pain relief and give the vaccine.
  • Pain during the rash. Acetaminophen or ibuprofen, with prescription pain medicine for severe cases.
  • Pain after the rash is treated as nerve pain. The UK instruction is to offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin, and capsaicin cream can be considered for pain in one small area. The Canadian Pain Society lists topical lidocaine, applied to the painful skin, as a second-line option for postherpetic neuralgia specifically; ask your prescriber or pharmacist which form is available here. The goal it sets is pain that is tolerable.
  • Acupuncture: some trials, low confidence. A 2019 review pooled eight trials with 498 people who had postherpetic neuralgia and concluded acupuncture may reduce pain. The comparison groups were given medicines such as carbamazepine and pregabalin, and one trial used sham acupuncture. Seven of the eight gave no details of blinding, the results varied widely, and larger, better trials are needed. A Cochrane review of acupuncture for nerve pain in general found insufficient evidence to support or refute it.
  • TENS: cannot say. A Cochrane review of 15 studies and 724 people with nerve pain rated the evidence very low and could not state whether TENS is effective.

Preventing shingles: the vaccine

Canada’s immunization guide recommends the shingles vaccine (Shingrix) for people 50 and older, and for adults 18 and older whose immune system is or will be weakened, unless there is a medical reason not to have it. It is two doses, two to six months apart. In Ontario it is free for people aged 65 to 70 through a doctor, nurse practitioner or participating pharmacy; outside that age range you can still get it by paying for it, and some insurance plans cover it. Region of Waterloo Public Health carries the same advice on its shingles page.

You can get shingles more than once, so adults 50 and older who have had it should still be offered the vaccine. It is not given during an episode; the interval is at least one year afterwards.

How each CARESPACE service treats shingles and postherpetic neuralgia

Nurse Practitioner

Shingles needs a diagnosis and a prescription, and in Ontario both are within a Nurse Practitioner’s authority. A Nurse Practitioner can examine the rash, prescribe an antiviral and pain medicine, and send you on urgently if an eye is involved. For pain that outlasts the rash, they can prescribe and adjust the nerve-pain medicines above, or refer you to a pain specialist. The three-day window matters more than who you see: if you cannot get an appointment in time, go to your own physician, a walk-in clinic or urgent care.

See our nurse practitioner team →

Acupuncture

Acupuncture is a non-drug treatment that has been tested in postherpetic neuralgia, and the quality of the trials is the limit on what can be said: it may reduce pain. The review covered pain that had persisted for more than a month, with definitions that varied between trials, so it says nothing about needling in the first weeks of the rash. An acupuncture practitioner can treat pain that has outlasted the rash, alongside medical treatment and not in place of it. Agree on a trial number of sessions and judge it by your pain and sleep.

See our acupuncture team →

Other services people ask about

Physiotherapy. The Canadian Pain Society names physiotherapy and exercise programs as part of managing long-term nerve pain in general. We found nothing that tested them for postherpetic neuralgia, and the evidence for TENS is very low. Massage Therapy and Naturopathic Medicine. Neither was tested for shingles, or the pain after it, in anything we read. Skin with postherpetic neuralgia can be painful to light touch, so say so before any hands-on treatment. Talk to a pharmacist, physician or nurse practitioner before taking a supplement for it.

Where most people start

With a rash now: a physician or nurse practitioner, today or tomorrow. With pain that has stayed after the rash healed: a Nurse Practitioner or your own physician, to talk about nerve-pain medicine. Acupuncture is an optional addition at that stage.

How your team works together

Shingles is a medical condition, and for most people one prescriber is the whole team. Acupuncture can sit alongside for lingering pain if you want to try it.

Browse by service: nurse practitioners and acupuncture.

What to expect at your first visit

  1. Dates. When the pain started and when the rash appeared, because of the three-day window.
  2. A look at the rash: where it is, whether it stays on one side, and whether it is near an eye.
  3. Your health. Age, pregnancy, conditions or medicines that affect the immune system, and what you take.
  4. Before you go, a plan: a prescription if one is appropriate, how to look after the rash, and what should bring you back. For pain after the rash, the visit covers where it is, what touch does to it and what you have tried.

What you can do at home

  • Take antiviral medicine exactly as prescribed.
  • Do not scratch or pick at the blisters; scratching can let an infection in.
  • Keep the rash clean and cover it with a non-stick dressing. Alberta’s advice adds a thin layer of petroleum jelly underneath.
  • Wear loose clothing, and try a cool compress a few times a day.
  • Use acetaminophen or ibuprofen as the label directs. A pharmacist can advise.
  • Until the blisters have crusted, stay away from pregnant people who have not had chickenpox, babies under one month old and anyone with a weakened immune system.
  • Stay off work or school while the rash is oozing and cannot be covered.

Outlook

The rash takes two to four weeks to heal. Pain can carry on for weeks after that and usually improves. When it lasts beyond 90 days it is postherpetic neuralgia, which can continue for months or years and is more likely the older you are. The sources give no figure for how long it lasts on average.

Shingles pain treatment in Kitchener, Waterloo and Cambridge

A new rash needs a physician or nurse practitioner within three days, wherever you can be seen soonest.

Kitchener. Acupuncture in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nurse Practitioner in Waterloo and Acupuncture in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Acupuncture in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How quickly do I need to be seen for shingles?

Within three days of the rash appearing, because that is when antiviral medicine works best. The same day if the rash is on your face, especially near an eye or on the tip of your nose, or if your vision changes.

Can a pharmacist prescribe for shingles in Ontario?

Not at present. The Ontario College of Pharmacists lists shingles among conditions that are not yet within pharmacists’ prescribing scope. A pharmacist can advise on pain relief and can give the vaccine.

How long does the pain last after shingles?

Often a few weeks after the rash heals, improving with time. Pain that lasts more than 90 days from the start of the rash is postherpetic neuralgia and can go on for months or years. See a physician or nurse practitioner if you still have pain a month after the skin has healed.

Should I get the vaccine if I have already had shingles?

Yes. You can get shingles more than once, and adults 50 and older who have had it should still be offered the vaccine, at least a year after the episode.

Where can I get help with shingles pain in Cambridge?

Acupuncture in Cambridge is an option for pain that has outlasted the rash. For a new rash, see a physician or nurse practitioner within three days. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Peripheral Neuropathy
Trigeminal Neuralgia
Chronic Pain
Bell’s Palsy

The CARESPACE Central Reception Team

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