PHN, Postherpetic Neuralgia or a long ride with Shingles?

It’s a little over three weeks since my Rut-and-Shingles post, so about three months since diagnosis and the ongoing pain. Clinically, Postherpetic Neuralgia (PHN) is nerve pain that keeps going 90 days after the shingles rash starts. I’m not a doctor—I just wanted a simple label for the pain, the timeline, and what I tried. I’ll explain the pain and the progression, plus a little reading that says it’s the long tail of shingles, not PHN. And yes, some running news.

In my post about registering for The Rut and shingles, I skimmed the early treatment and the worsening pain. With a little more time (and humility), here’s a clearer look back.

No Way! It’s shingles? I thought that’s just a rash, this feels like hell.

Early–mid November: I was on a mountain bike trip with my oldest, riding strong and feeling good. Later, in the van getting ready for dinner, my chest tightened a few nights in a row. I didn’t say anything. Couldn’t be my heart, right? By Thanksgiving, the pain was nearly constant and ramping—like a strap cinched across my chest—and I started to wonder. The detail I missed: it was right‑sided, wrapping under my arm into my back. No rash to clue me in until the morning of my appointment for the chest pain. Even then, I figured it was some kind of reaction. In clinic: shingles. Prescription: antiviral. The rash never got dramatic—no horror‑show blisters—and it dried up in about a week. The pain stayed.

The pain lived along the ribs—intercostal, band‑like—and it built through the day. Nights were the worst: no sleep, up and down, TV in the middle of the night, and don’t even think about touching me. After the skin cleared, anything on it—a sheet, a T‑shirt, a breeze—felt like sandpaper. The stabbing wasn’t just pain; it was the torture of not knowing when the next spike would land—20 seconds, two minutes, ten. I caught myself bracing for hits that might not come. Early on I didn’t want to move or be still; bed was the only place I could roll and wedge into positions that blunted it. Standing hurt in a bone‑deep way, and the muscle ache was its own kind of fatigue.

As I started to improve and get up more, evenings ambushed me. Was it actually better, or was I just fighting back? Cooking—something I love—turned into a horror show. I’d hunch over the counter like rounding my back might take pressure off my frame, muscles, and skin. It didn’t. I was lousy to live with. I could fake normal until late afternoon; by evening, I was done. Lidocaine slather. Too much ibuprofen. Old oxy from a drawer. I forced short runs. The first minutes were rough, but if I could settle in, moving helped me feel human for a bit. Thirty minutes, tops—but at least I was moving.

Medication & Dietary Triggers

On the med front, I’m not sure anything other than ibuprofen and the early oxy clearly helped in the moment. The build‑and‑taper meds are harder to judge—was I improving, or was it the drug? I started gabapentin and, being me, took more than prescribed when it didn’t seem to help. I messaged my doc: not working, I need something else. The cold‑turkey switch? Hell on earth.

Then pregabalin (Lyrica) 750 mg twice daily with 400 mg ibuprofen—still not enough—so I added a midday dose. That finally took the edge off, I think. About two weeks ago I dropped back to the prescribed two doses, and a few days ago I tested one 750 mg tablet in the morning, no ibuprofen. It’s doable most days; when it isn’t, I toss in 200 mg of ibuprofen and move on. That pattern—neuropathic meds providing “edge‑off” rather than a cure—is common with shingles‑related nerve pain and PHN.

Trying to understand my body and cues, I started testing triggers. I cut caffeine to one small cup in the morning (down from three to four through the day) and suspended alcohol—traded the beer while cooking dinner and the cocktail after for NA beer or a glass of tonic with a sprig of rosemary. I think both helped, especially the alcohol. For many, stimulants and alcohol can amplify nerve irritability or sleep disruption, which worsens pain perception; dialing them back is a reasonable self‑test.

Looking back, not PHN but not ‘just’ Shingles

So am I over shingles and never really in PHN territory? I think so. If your pain began with the rash and eased by around the three‑month mark, that fits the “long tail of shingles” more than formal PHN. PHN isn’t a different disease—it’s the name for shingles‑related nerve pain that persists beyond 90 days. I’m down to a single 750 mg morning dose of Lyrica, no ibuprofen, no oxy. In the end, it was about three months, start to finish. What’s left are the “hot spots” and little flashes toward the end of the day—if you’ve had it, you know. I’m back. I’m taking the lessons and moving on: five days a week of running, some skiing with friends, mountain biking with my oldest when the weather allows. And, as always, being Nate’s dad and getting him out there.

When the pain dragged on and nothing seemed to work, I did what you’re not supposed to do: I read too much online. The more I scrolled, the more I convinced myself I’d be one of those year‑long cases, stacking meds that didn’t help. I can tilt dark with pessimism—some hard things have landed right when life felt brightest for our family—and I went there.

So, here we are. I still get ‘lit up’ as I call it. Flairs of pain that sit in that primary area on my left side. I know it’s triggers for the most part and will take it as it comes until, possibly, it stops all together. But this I can handle. I hope to stop the Lyrica all together in a couple weeks.

Postherpetic Neuralgia really is brutal for those who really suffer it

But when the slope finally tipped toward better, it happened fast. I realized I was okay. I have it better than so many, and true PHN is a brutal, debilitating illness. Most shingles pain fades within weeks to a few months. But for a minority—especially older adults, or folks who had severe early pain/rash or eye involvement—the pain doesn’t stop at 90 days. That’s PHN. It can run for many months, and for some, years. Day to day, it’s not “just pain.” It’s allodynia so intense that cotton feels like grit; showers sting; waistbands and bra straps are negotiations; sleep becomes a puzzle of pillows and positions; exercise, intimacy, and simple hugs can feel off‑limits.

PHN is neuropathic—the nerves are inflamed or damaged and fire unpredictably—so the pain can be burning, electric, or stabbing, with spikes you can’t time or control. Mood and energy take hits: anxiety about the next jolt, irritability from poor sleep, and the grind of planning life around flare windows. Treatments (gabapentin or pregabalin; tricyclics or SNRIs; topical lidocaine or capsaicin; sometimes short‑term opioids) aim to quiet misfiring nerves. They rarely erase the pain; the win is dialing it down enough to function. For tougher cases, pain clinics may add nerve blocks, TENS, mindfulness/CBT, and sleep work. It’s a long haul, and it can be life‑altering.

That’s why I’m grateful my course looks like the long tail of shingles, not entrenched PHN. To the people living with PHN into months four, five, six and beyond—you’re carrying weight most folks can’t see, and it’s heavy. If you’re there, you deserve full‑court support: pain management, sleep help, mental health care, and patience from the people around you.

Separate but important: prevention matters. The shingles vaccine (Shingrix) cuts the risk of shingles and PHN dramatically, especially as we age. If you’re eligible, it’s worth a hard look.

Further reading and key resources

• Centers for Disease Control and Prevention – Shingles and vaccination
  Overview of shingles, who is at risk, and detailed guidance on the recombinant zoster vaccine (Shingrix), including who should get it and expected side effects.
  https://www.cdc.gov/shingles/vaccines/index.html​
• American Academy of Family Physicians – Recombinant Zoster Vaccine (Shingrix)
  Evidence‑based review of Shingrix from primary‑care perspective, summarizing trial data on how well it prevents shingles and postherpetic neuralgia in adults 50 and older.
  https://www.aafp.org/pubs/afp/issues/2018/1015/p539.html​
• StatPearls (NCBI Bookshelf) – Postherpetic Neuralgia
  Clinical review of PHN covering mechanisms, risk factors (especially age and severity of the acute episode), treatment options, and prognosis.
  https://www.ncbi.nlm.nih.gov/books/NBK493198/​
• Mayo Clinic – Postherpetic Neuralgia
  Patient‑friendly explanation of symptoms, diagnosis, and treatment approaches for PHN, including when to seek specialty care.
  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593​
• Systematic review – Risk factors for postherpetic neuralgia
  Research synthesis describing how age, early pain intensity, and rash severity increase the likelihood of developing long‑lasting PHN after shingles.
  https://pmc.ncbi.nlm.nih.gov/articles/PMC4685754/​