Acupuncture for postherpetic neuralgia

Acupuncture may help the burning, touch-sensitive pain that lingers after shingles, but the evidence is modest. A 2019 meta-analysis rated the evidence for lower pain intensity as moderate quality, while a 2018 review found the trials too weak to show it beats nerve-pain medicines. It is best added once the rash has fully healed, alongside the treatment your doctor or pain clinic has started, with needles placed around rather than on the most sensitive skin.

Postherpetic neuralgia is the nerve pain that stays in the strip of skin where shingles was, sometimes for months after the rash has gone. Acupuncture is one of the things people add when medicines only take the edge off, and reviews suggest it may lower pain intensity and help with anxiety and quality of life. The trials behind that are mostly small, and none show it outperforms prescription nerve-pain medicine, so we treat it as support alongside your doctor’s plan.

Our role depends on timing. While shingles is active, we refer you to a pharmacist or doctor first. Once the rash has healed, acupuncture can be a reasonable addition.

What postherpetic neuralgia feels like, and who gets it

Shingles is a reactivation of the chickenpox virus. It usually causes a painful, blistering rash on one side of the body, most often the chest and tummy, though it can appear on the face, eye or genitals. The NHS says the rash can take up to four weeks to heal.

Postherpetic neuralgia is the pain that outlasts the rash. It can feel like:

• aching, burning or sharp pain that may be constant or come and go
• skin so sensitive that light touch, clothing or temperature changes hurt
• itch, or patches of numbness

It is more likely after severe or widespread shingles, and more common in older people and people with diabetes or a weakened immune system. Getting shingles treated quickly, and having the shingles vaccine, both lower the risk.

What doctors use first

Postherpetic neuralgia can be hard to treat, which is why the NHS describes a stepped approach:

Step	What a doctor may offer
Mild to moderate pain	Paracetamol, or paracetamol with codeine
Nerve pain that persists	Amitriptyline, duloxetine, gabapentin or pregabalin, started low and increased over weeks
Mild pain, or when tablets do not suit	Lidocaine plasters
Severe pain	Tramadol for a short time
Pain affecting daily life	Referral for cognitive behavioural therapy, a neurologist or a pain clinic

Nerve-pain medicines often take a few weeks to work, so it is worth giving them a fair trial before deciding they are not helping. Acupuncture fits beside these steps; it is not a substitute for any of them.

What the acupuncture evidence shows

Three papers give a balanced view.

• 2019 meta-analysis (Pei and colleagues). Acupuncture lowered pain intensity, eased anxiety and improved quality of life compared with controls. Using the GRADE system, the authors rated the evidence for pain intensity as moderate quality, and called for larger, better trials.
• 2018 meta-analysis (Wang and colleagues). Seven trials compared acupuncture with drug treatment. Two showed lower pain scores with acupuncture, but overall there was not enough evidence that acupuncture beats medication for global improvement or quality of life. No adverse effects were reported, and all trials were done in China.
• 2019 reporting review. Across 137 trials of acupuncture for this condition, reporting quality was generally sub-optimal, though it improved after 2010.

Put together, acupuncture looks safe and may help, but the size of the benefit is uncertain. A sensible approach is a defined trial of sessions while you keep a daily pain diary, as the NHS also suggests.

How we approach sensitive skin

The defining feature of this pain is that the skin itself can hurt to touch. Needling straight into that strip would often make a session miserable, so the usual approach is to work around it:

• Around the edges of the painful band, where skin tolerates contact
• At distant points on the limbs or back, part of how acupuncture point selection works (our page on local, distal and ashi points explains the idea)
• With other methods in the literature, such as electroacupuncture, which the 2019 review also found lowered pain intensity

You stay in charge of where we touch. If a point feels wrong, say so and it comes out.

How this works at Renu

In our West Hillhurst clinic, acupuncture for nerve pain is provided by Dr. Will Tanner, who is also a Registered Massage Therapist. A first visit is a 90-minute initial consultation and treatment ($150), then 60-minute return visits ($120) or 45-minute follow-ups ($85).

Before booking:

1. Make sure the rash has fully healed. No blisters, no weeping, no open scabs.
2. Bring your medicine list, including doses and when each was started.
3. Bring a few days of your pain diary, scoring the worst pain and noting what sets it off (clothing, a breeze, a shower).

At home, the NHS suggests loose cotton or silk clothes, covering sensitive skin with a dressing or cling film under clothing, a wrapped ice pack for up to 20 minutes every 2 to 3 hours, and cool showers. Calgary’s dry winter air and wool layers can be hard on sensitive skin, so softer base layers may help. If the pain is on your face rather than your trunk, read our page on acupuncture for trigeminal neuralgia, since the two are easily confused.

When to see a doctor first

See your family doctor if you have had shingles and pain where the rash was is not getting better. That is the NHS’s advice, and it is the right first step before any acupuncture.

Get urgent medical advice, the same day, if you have shingles symptoms and:

• the rash is on or near your eye or nose, or your vision changes
• you are pregnant
• your immune system is severely weakened, for example from chemotherapy
• you are breastfeeding and the rash is on your breast

Antiviral medicine works best when started within three days of the rash appearing, and a pharmacist can provide it. While the rash is still weeping, avoid contact with anyone pregnant who has not had chickenpox, people with weakened immunity, and newborns under one month, which is also why it is best to wait before coming into the clinic.

If the pain is severe, spreading or affecting sleep and daily life despite medicine, ask about a referral to a pain clinic. Health Link at 811 can help you decide how urgently to be seen.

Questions people ask

How long does postherpetic neuralgia last?

The NHS says it usually gets better eventually, but the time varies from a few months to more than a year. That long, uneven course is one reason a pain diary helps: it shows whether a treatment is speeding things along or whether the pain is simply easing on its own.

Can I get acupuncture while I still have the shingles rash?

It is best to wait until the blisters have dried and healed. While the rash is weeping, people who have never had chickenpox can catch it from you, and a clinic offering prenatal and oncology massage sees exactly the people who should avoid that. Early antiviral treatment from a pharmacist or doctor, ideally within three days of the rash, matters far more at that stage.

Is massage safe with nerve pain after shingles?

Usually, as long as the therapist stays off the painful strip and the rest of the body is treated gently. Even light touch can hurt in postherpetic neuralgia, so tell us exactly where the boundary is. Our answer on whether a massage can damage a nerve covers the wider question.

Does the shingles vaccine help if I already have nerve pain?

The vaccine lowers the risk of getting shingles and postherpetic neuralgia, and you can get shingles more than once. It is not a treatment for pain you already have. Ask your doctor or pharmacist whether you are eligible.

Sources

1. NHS: Post-herpetic neuralgia
2. NHS: Shingles
3. Pei W et al., Journal of Pain Research 2019: Is acupuncture an effective postherpetic neuralgia treatment? A systematic review and meta-analysis
4. Wang Y et al., Medicine 2018: Acupuncture for postherpetic neuralgia, systematic review and meta-analysis
5. Liu K et al., Journal of Pain Research 2019: Reporting quality in randomized controlled trials of acupuncture for postherpetic neuralgia
6. Alberta Health Services: Health Link 811

Page reviewed October 5, 2026. This page is education, not a diagnosis. For your own situation, talk to your doctor, surgeon or care team, or ask us.