The pain from shingles occurs more frequently and lasts longer in the elderly and in patients with weakened immune systems. Children and young adults rarely have significant pain and thus rarely need any treatment for shingles. However, if an individual who develops shingles is at high risk for severe or prolonged pain, there are a variety of potential treatments. These include specific antiviral medications such as acyclovir, famciclovir, or valocyclovir, which work best if started in the first three days of the rash. The role of steroids such as prednisone is controversial, with some studies showing moderate benefits and other studies showing no benefits.
If the shingles is accompanied by significant pain, there are many ways to treat the pain, depending on whether it lasts for days, weeks, or months. These include over-the-counter pain medication, narcotics, certain antidepressants and antiseizure medications, nerve blocks, lidocaine patches, and a certain pain cream called capsaicin. Capsaicin is an over-thecounter remedy that works to deplete the painimpulse transmitter substance P in the skin where the cream is applied. Unfortunately, even with all these methods, the pain following shingles sometimes cannot be relieved, and affected individuals may suffer for months.