Shingles Pain Duration Without Antivirals: Typical Course and Complications

Natural History of Untreated Herpes Zoster Pain

• Acute phase: 2–4 weeks of radicular pain, vesicles, inflammation.
• Subacute: Pain may persist 1–3 months as lesions heal.
• Postherpetic Neuralgia (PHN): Pain lasting >90 days after rash onset; occurs in ~10–18% of cases, higher with age (>60) and severity.
• Chronic PHN: Can last years; neuropathic pain mechanisms.

Antiviral Impact

Early antivirals (within 72 hrs) reduce acute severity, viral shedding, and PHN incidence by ~50%. Strongly recommended for all immunocompetent adults and all immunocompromised patients.