Chad Bernhard learned how fierce shingles pain can be in his mid-30s. He first noticed an itchy rash on the left side of his chest and back that quickly turned into “kind of like the whole side of your body was being stung by hornets, continuously,” he says. He later experienced shingles a second time.
Shingles is a reactivation of the varicella-zoster virus that causes chickenpox. After an initial infection the virus can remain dormant in a nerve root for years; when it reawakens it inflames the nerve and breaks through the skin, producing blisters, itching, burning and often intense pain, explains Dr. Maria Carney, a geriatrician.
About one-third of Americans will develop shingles during their lifetime, but a two-dose vaccine dramatically lowers that risk. The currently recommended vaccine requires two shots spaced over several months. Even so, only 36% of adults age 50 and older had received at least one dose by 2022. Doctors emphasize vaccination because shingles can be debilitating and complications may be long-lasting.
Four things to know about shingles, the vaccine and treatment
1) Shingles can hit younger than you expect
– Public health guidance recommends vaccination starting at age 50, when immune defenses commonly begin to decline and insurance coverage is typically available. Still, many people get shingles well before age 50.
– Bernhard’s episodes occurred during periods of intense physical exertion, such as long bike rides. Dermatologist Dr. Sheryl Clark notes that physical or emotional stress can weaken immunity and trigger viral reactivation. Local skin trauma—like a scrape or burn—can also provoke symptoms in the injured area.
– The incidence of shingles increased substantially from the mid-20th century through the early 2000s; reasons are not fully understood but changes in stress, diet and other population-level factors may contribute. Newer research links chronic conditions such as diabetes and asthma to higher shingles risk among younger adults.
– People who received the childhood chickenpox vaccine generally have lower shingles risk later on, though because that vaccine contains a weakened live virus there remains a very small chance of reactivation.
2) The vaccine may offer added benefits
– Emerging studies suggest shingles vaccination might be associated with other health benefits. A December study reported a possible link between shingles vaccination and lower dementia risk. Another study found slower markers of biological aging in vaccinated people.
– Gerontology researcher Eileen Crimmins observed reduced inflammation among vaccinated participants in work that used the older Zostavax vaccine (withdrawn in the U.S. in 2020). The current vaccine, Shingrix, is more potent and more effective, which could imply even stronger benefits—but these findings are correlational and need further study.
3) Recognize symptoms and seek early treatment
– Early signs include tingling, unusual skin sensitivity, a rash or sudden severe pain. Antiviral medicines work best when started within the first few days of an outbreak.
– Alison Meadow, a college professor, scraped her knee while running and then developed pain far worse than expected; a rash followed and her doctor diagnosed shingles. She was prescribed antivirals but warned that late treatment may be less effective. Clinicians urge prompt evaluation when symptoms begin.
4) Symptoms can persist for months or years
– A minority of patients develop post-herpetic neuralgia, persistent nerve pain that can continue long after the rash heals. Meadow, who was 47 when she got shingles, says pain in her leg has lasted five years and has substantially affected her life.
– She paid out of pocket to get vaccinated before turning 50 to lower the chance of recurrence. A 2024 study estimated that 1% to 10% of people with shingles will experience a recurrence.
– Treatments for chronic shingles pain vary; some drugs cause intolerable side effects for some patients, while newer therapies can be more tolerable and effective. Meadow reports major improvement on a newer medication and has been able to resume light jogging.
Bottom line
Shingles can occur well before age 50 and can produce severe, long-lasting pain. The two-dose vaccine recommended at age 50 substantially reduces the likelihood of shingles and its complications, and early antiviral treatment improves outcomes if an outbreak begins. If you feel tingling, abnormal sensitivity or a painful rash, seek medical care promptly.