Herpes zoster (HZ) results from reactivation of latent varicella zoster virus (VZV). In immunocompetent persons, the most notable manifestations of HZ (shingles) are rash, acute neuralgia (pain occurring within 30 days of disease onset) and persistent pain, termed postherpetic neuralgia (PHN). The majority of patients rate acute pain as moderate or severe within the first 72 hours of rash onset, and this acute pain interferes with daily activities and reduces emotional, physical and social functioning. PHN, the most challenging and debilitating complication of HZ in immunocompetent hosts, can last for weeks, months or even years, influencing patient’s perception of pain and impairing their social and occupational life. Older age and a greater severity of acute pain are among the best supported risk factors for developing PHN. The effects of acute as well as persistent pain on physical and emotional functioning have been examined in several studies. Given the major impact that the pain associated with HZ has on a patient’s quality of life and the social burden, a compelling aim of treatment is to minimize its severity and duration. Current strategies for HZ management and PHN prevention are only partially effective. Prompt antiviral therapy for HZ and relief of acute pain, and the recent introduction of zoster vaccination programmes, are expected to reduce the negative impact of this pathology on the patient’s quality of life. Further research on herpes zoster pain pathophysiology and its relationship with viral reactivation is warranted to overcome this unmet medical need.

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