Shingles often starts as burning, tingling or stabbing pain in a band on one side of the body, a few days before any rash appears. People reach for a heat pad because it feels like a muscle problem. It isn’t, and heat is the wrong response.
What shingles is
The chickenpox virus stays dormant in nerve roots after childhood infection.
Years later it can reactivate and travel along one nerve, causing pain in the strip of skin that nerve supplies. That’s why the rash appears in a band, on one side only, and stops at the midline.
Common sites are the ribs and back, but it can appear on the face, neck or limbs. That’s also why it gets mistaken for a rib or chest wall strain, or for shoulder blade pain.
Clues it isn’t muscular
- The pain is burning, electric or stabbing rather than a dull ache
- It’s in a band on one side and doesn’t cross the middle of your body
- It doesn’t change much when you move or change position. Muscular pain almost always does: see is it muscle pain?
- The skin is extremely sensitive, so even clothing hurts
- You feel generally unwell, sometimes with a headache or mild fever
Why not heat
Once the rash appears, the skin is broken: blisters, then crusting. Heat on broken skin risks damage and infection, and the area is usually too sensitive to tolerate a pad anyway. Heat also does nothing for nerve pain, for the same reason it does nothing for the shooting leg pain of sciatica.
The bigger risk is delay.
Antiviral treatment works best when started within about 72 hours of the rash appearing, and it can reduce the chance of lingering nerve pain afterwards. Days spent treating it as a pulled muscle are days lost.
See a doctor now if…
- You have a painful band of blisters on one side of your body
- Burning one-sided pain is developing and you’ve had chickenpox in the past
- The rash is on your face, near your eye, or on the tip of your nose. This can threaten your sight and needs same-day care.
- You have a rash with hearing loss, dizziness or facial weakness
- You’re pregnant, immunosuppressed, or on chemotherapy
- The rash is spreading widely rather than staying in a band
While it settles
- Keep the rash clean, dry and loosely covered
- Loose cotton clothing over the area
- A cool compress is usually more comfortable than a warm one. See hot compress vs cold compress.
- Pain relief as advised by your doctor. Nerve pain often needs different medication from ordinary painkillers.
- The blisters are infectious to anyone who hasn’t had chickenpox, so keep away from newborns, pregnant women and anyone immunosuppressed until they crust over
Once the skin has healed
Some people have lasting nerve pain in the same area, called post-herpetic neuralgia. That is managed by your doctor with medication suited to nerve pain. A heat pad on fully healed skin may be comforting, but only if sensation in that area is normal, and it won’t treat the nerve pain itself. For living with pain that persists, see a chronic pain flare plan.
More on where heat is unsafe: who should not use a heating pad.
Clinically reviewed by: Nigel Chua (Hand Occupational Therapist) & Louise Yow (Physiotherapist). This article is general information, not a diagnosis. electricheatpad.com sells electric heat pads.
