Pain Blog

Intercostal Nerve Block for Shingles Pain and Post-herpetic Neuralgia Pain?

Many of you have been contacting us for evaluation of your shingles pain, or chronic pain in the same area once the shingles have healed (known as post-herpetic neuralgia pain). This is a very frustrating disease that can be very painful and debilitating. There is good treatment for it however! The problem is that most physicians, including your primary care physician, do not know about this treatment. Its been around for almost a century and is called an intercostal nerve block or nerve root block. Today, I perform it using an xray machine to guide a very thin needle very accurately to the nerves that have shingles. Then, I inject a numbing medication similar to lidocaine, and also an anti-swelling medication around the nerves. This results in complete pain relief immediately in over 90% of cases, and lasting pain relief in many cases as well. It does work quite well and is something we can offer you here at the clinic if you are interested. By using an xray machine you can be assured the injection is as accurate and efficacious as possible!

About the Author

Jason G. Attaman, DO, FAAPMRDr. Attaman is board certified and Anesthesiology-fellowship trained in the medical subspecialty of Pain Medicine and Interventional Pain Management. He is also residency trained and board certified in the specialty of Physical Medicine and Rehabilitation. He is one of only a few with such extensive qualifications in the state of Washington. Connect with Dr. Attaman on Google+ | LinkedIn | Facebook If you are in pain, call Dr. Attaman's Seattle office (206-395-4422) or Bellevue, WA (425-247-3359) office.View all posts by Jason G. Attaman, DO, FAAPMR »

  1. Peggy & Fred
    Peggy & FredJan 10, 2014

    My husband has had post herpetic Neuralgia pain for over 10 months. He has had injections in his spine in the first 2 months of pain, but it did not help at that time. Is there any hope now? The procedure was not called a nerved block?

    • attaman
      attamanJan 10, 2014

      Dear Peggy and Fred,

      Yes, there are many options to help. Please call my clinic to make and appointment. Kind Regards, Dr. Attaman

  2. Charles G.
    Charles G.Sep 04, 2014

    Dear Sir, I have had PHN for over 20 years. I am currently using electrical spine stimulation to help get by. The Process is beginning to cease stemming my pain to the point that I can not stand air blowing over my skin. Will your method of stopping the pain work? And if it works, how long will it last. Washington is a long distance from KY. Are there other means of helping my problem? Ablation? No drug will help. Shingles are nothing compared to the damage they can cause. Respectfully, Charles G.

    • Jason Attaman
      Jason AttamanOct 03, 2014

      Dear Mr. G,

      There are still a number of treatment options for you. It is possible other options will help you. It would not be possible to give you an estimate of how long the pain relief may last as I have not evaluated your case. I agree, post-herpetic neuralgia (the chronic pain that comes after a shingles attack) can be horrible. I would be happy to evaluate you as we often have people traveling in from out of state for treatment with me. Alternately, I can strongly recommend Dr. Steven Lobel in Canton, GA which would be closer to you. His website is

      Kind Regards, Dr. Attaman

  3. G. S.
    G. S.Nov 11, 2014

    I live in Cumming, Ga. Can you recomment a Doctor who uses the same treatment as you in Cumming, Ga? I have terrific pain for 2 and 1/2 years as a result of shingles.

  4. Joan
    JoanJan 09, 2015

    I am considering a nerve block for postherpetic neuralgia. What is the difference between this procedure and epidural with corticosteroids?

    • Jason Attaman
      Jason AttamanJan 10, 2015

      Dear Joan,

      With an intercostal nerve block, the nerves in between your ribs are injected with numbing medication and a steroid medication. This decreases the pain going along these nerves. You can read about the intercostal nerves by clicking here:

      With an epidural steroid injection, similar medication is injected in the spinal canal. Usually this is used when the nerves are pinched inside the spinal canal from a disc bulge, or spinal stenosis. Although an epidural steroid injection can help with intercostal neuralgia, generally this is not the first line treatment used, as an intercostal nerve block is usually used to deliver medication to the painful intercostal nerves.

      Best Regards, Dr. Attaman

  5. Terry
    TerryJan 22, 2015

    Are there any side effects to this treatment, and would you recommend it for an 81 year old woman?

    • Jason Attaman
      Jason AttamanJan 22, 2015

      Yes, there are side effects to any treatment. The side effects of this treatment are very rare and generally minor. This procedure would be appropriate for a person of any age. Kind Regards, Dr. Attaman

  6. Betty
    BettyMar 24, 2015

    I’m thinking about getting epidural steroid injection for p.h.n pain from shingal is it the same as nerve block will I be pain free.I really don”t know what to do. Thank you if You can give me some advise

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRMay 01, 2015

      Betty I cannot give you specific medical advice over the internet, however epidural steroid injections may help. I cannot say if it is the same as a “nerve block,” as I do not know your physician. Best of luck, Dr. Attaman

  7. Anonymous
    AnonymousApr 24, 2015

    I have shingles above my right eye and scalp. The itching, pain and numbness is unbearable. I live in Carmel Indiana, do you know of s physician I can cannot here? I am so upset over this and with nothing helping.

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRMay 01, 2015

      Hello, I would strongly recommend you see Michael Whitworth, MD who has a practice in Indiana. He is one of the best pain physicians in the world! Dr. Attaman

  8. Olya M
    Olya MJul 30, 2015

    Dear doc,
    My elderly mother is suffering from post herpetic neuralgia for over 6 months now. We finally saw a pain specialist and he put her on oral steroids for a week. She did not have any pain at night while sleeping and after taking the steroids can no longer sleep at night as they made the pain come back. During the day she is in pain all the time. Her doctor offered a nerve block and I’m not sure if thats something we should do but I cannot see Her suffer like this… I’m infuriated that the Meds he put her on made the night time pain come back… Do you know any doctors in Tampa Bay Area of Florida tvat take Medicare and Medicaid aka United health and Medicaid to help someone like my mom without pumping her full of drugs… Thank you so much

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRAug 01, 2015

      Dear Olya,

      I do not know anybody in particular to recommend in your area. In general, nerve blocks work quite well for post herpetic neuralgia and I’d encourage that option. Kind Regards, Dr. Attaman

  9. Christine Millard
    Christine MillardAug 31, 2015

    I have experienced PHP for almost three years now. have been to various pain Doctors. Am on my last nerve. Can’t can’t the pain any more. In the two 1/2 years I have had this I have NEVER been presented with this procedure. I did have an epidural, but that was for my back and did not work. I want to get out of pai, but I am afraid of these procedures. I don’t know if the Dr’s around here even know about this procedure. I live in the Reno, Carson, Lake Tahoe area and am not far from the Bay area. Is this a procedure that any pain Dr. thinks he can do and really doesn’t know about it. Any information would be helpful.Thank you

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRSep 01, 2015


      Though it is my opinion that any pain doctor should be able and willing to treat pudendal neuralgia, most refuse to for reasons unclear to me. I would be happy to see you in consultation. We have many patients visiting from out of state for treatment of pudendal neuralgia and we are happy to have you. Kind Regards, Dr. Attaman

  10. Betty Griesing
    Betty GriesingSep 13, 2015

    Can you recommend a doctor in Dallas/Ft Worth Texas area to perform Intercoastal Nerve Block? Where are you located?

  11. Y Corbett
    Y CorbettOct 17, 2015

    Do you know of any doctors in the Kalispell, Mt area that does an intercostal nerve block or nerve root block. I am going in next week for an epidural, but would be interested in looking into this procedure. Thank you for any help you can give me.

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMROct 17, 2015

      I do not know of any physicians personally in that area, but any physician capable of an epidural steroid injection should be more than capable of performing intercostal nerve blocks. I’d ask your physician if this procedure is right for you. Best of luck! Dr. Attaman

  12. Jamie
    JamieNov 16, 2015

    Hello Dr. Attaman,

    I stumbled upon your blog as I was doing some research on PHN for a client of mine who has been suffering from this condition for four years. He is 60 years old, very isolated, uses Medicare for insurance, and has been going to great lengths to try to find something that would alleviate the pain he experiences. He describes his pain as “like fire ants, eating away at my face all day.” He has tried a variety of medications, creams, and other treatment options. A lot of times his providers seem to treat him like garbage (perhaps out of their own frustration for not knowing how to treat his condition).
    I notice that you often reply to people who comment on here and I was wondering if you could help me by referring someone who might be able to help or by answering a few questions the client had passed on for me to ask. He does not have internet access and therefore I’m helping him out by reaching out to you.

    Thank you so much.

  13. Stan
    StanNov 27, 2015

    Dr. Attaman,

    My mother who is 87 is suffering from the after effects of shingles and is still in severe pain after 4 years. She said she had the nerve block done by a doctor in the Marietta area but still no relief. She had shingles in her scalp and eye area. The nerve block was done about a month ago. Does she have any other options. She lives in Marietta and is in very good health with the exception of the shingles pain.

  14. Dr Stefan Cohen
    Dr Stefan CohenDec 24, 2015

    My wife has PHH from shingles over the eye. Can you recommend a physician near Florida tha can cry out nerve block procedure . We are willing to travel .

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRDec 29, 2015

      Dear SC,

      I’m sorry to hear about this. V1 distribution PHN is very painful and difficult to treat. I’d suggest a visit to the Mayfield Clinic trigeminal neuralgia specialists for the most expedient solution. I do not know anybody personally in Florida who can help with this, though I am sure there are such physicians. Kind Regards, Dr. Attaman

  15. Kim
    KimJan 10, 2016

    My mom has post herpetic neuralgia in her head face eye. Nothing has helped. What procedure can be done? Who is in metro Detroit or if necessary we could travel .

  16. Paula Greer
    Paula GreerFeb 04, 2016

    Where is Dr Attaman and how can I contact him/

  17. Jordan
    JordanFeb 15, 2016

    Dr. Attaman.

    I have suffered from PHN on my upper back for the last 8 years. It was a bearable nuisance until a few months ago. Now, the pain is constant and interfering with the quality of my life. I have researched available treatments and believe intercostsal nerve block might help. Can you recommend a physician in Portland, OR? Also, can you comment on whether you believe Calmare therapy, frequency specific microcurrent (FSM) therapy, and IV Vitamin C therapy are viable alternative treatment options?

    I appreciate any guidance you can provide. Thanks!


    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRMar 09, 2016

      Dear Jordan,

      I would recommend Dr. David Russo in Hood River. He is an excellent pain doctor! Kind Regards, Dr. Attaman

  18. galina
    galinaFeb 22, 2016

    Can you recommend doctor in Sacramento/San Francisco area, CA? My husband has shingles pain for the last year after he had a stroke. Thank you, Galina

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRMar 09, 2016

      Dear Galina,

      There are many well known pain doctors in your area. I would suggest you visit Dr. Einar Ottestad at Stanford University. I’m sure he can help you. Kind Regards, Dr. Attaman

  19. Joe leduc
    Joe leducMar 06, 2016

    I had shingles when I was 6 years old, I am now 31 and have been told that I have phn. I started having pain about three years ago. Is it possible to go so many years without pain then start having pain. And if so I’m interested in this procedure.

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRMar 09, 2016

      Dear JL,

      Yes it is indeed possible to develop PHN many years after the initial episode of shingles, though fairly rare. I’d be happy to consult with you in clinic to figure this out. Kind Regards, Dr. Attaman

  20. Rudy
    RudyApr 06, 2016

    Dr. Attaman,

    I got the shingle on Feb 23rd and now have nerve pain that is by rib cage I’ve cried like a baby so many times because of the pain Do you know anyone in San Antonio Texas I’ve tried everything and I need of help

  21. Judith Smyser
    Judith SmyserApr 22, 2016

    Dr. Attaman, I’ve had post herpetic neuralgia for almost 6 years. At the beginning I tried what I thought was everything out there. drugs, most of which made me sick,accupunture, topical creams, TENS unit, Lidoderm patches, A Qutenza patch at Johns Hopkins, two epidurals, using depomedral and kenalog, and a nerve block using Namenda. Nothing seems to have worked. I stopped trying 2 years ago and am taking 4 gabapentin, 600 mg a day and 2 hydroco/apap 10-325 a day. Is your Intercoastal Nerve Block different than the epidurals , or the nerve block of the drug Namenda that I’ve had in the spine?

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRApr 24, 2016

      Dear Judith,

      Yes, an intercostal nerve block is different than an epidurals steroid injection. There are other options that can help you that you did not list. I’d be happy to see you in consultation. Kind Regards, Dr. Attaman

  22. Joe Pancottini
    Joe PancottiniMay 12, 2016

    Can I get any relief at all from the nerve block? I have been trying to deal with this for over 25 years and it keeps getting worse and worse with every outbreak and am tired of the narcotic pain medicine. Is there any hope left at all?

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRMay 14, 2016

      Dear JP,

      Yes, there are many options for the pain you have from shingles. I see people from around the country for this condition. I’d be happy to see you, too. Kind Regards, Dr. Attaman

  23. Gail Mollin
    Gail MollinMay 17, 2016

    ?How do you know exactly where the PNP from the healed shingles outbreak is to inject the intercostal nerve block if there is no longer any visible rash left.I am almost one year into my shingles outbreak last June and am suffering from aching and weakness simultaneously, across the leftt side of the Lowe spine extending upwards toward the left side of the mid spine,with some deep itching on the left mid section.

    Where are you located and do you know of any physicians in Philadelphia who are experienced in this procedure and perform it on a routine basis?

    This deep aching and weakness make it impossible for me to perform my daily routines and would do just about anything to get relief once I am more familiar with the possible side effects which must be clearly defined before any procedure is undertaken.
    Thank you,
    Gail Mollin

  24. Gail Mollin
    Gail MollinJun 30, 2016

    Can you tell me of any pain management doctors using intercostal nerve block for PHN in the Philadelphi, PA area…I really need hel0 locating a physician near home…Cannot afford to travel due to financial restrictions.

    Thank you for your attention to this inquiry…

  25. Chloe
    ChloeJun 30, 2016

    I’m 16. My mom is 51 and had shingles last year in May 2015. She has had PHN for a while now. We live in California. Nothing seems to help her with the pain. Does this really work? I hate seeing my Mother in pain everyday. Thank you

  26. Abby
    AbbyJul 11, 2016


    My 88 yr old grandmother has been dealing with this for the past 9 months and nothing seems to help. They are now trying the epidurals and that seems to make the pain worse. Can you recommend a doctor in the Tampa Bay area?

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRDec 17, 2016

      Dear A,

      I’m sorry to hear of your grandmother. I am not familiar with any pain doctors in that area. You may want to look to the pain clinic of the local university hospital. Kind Regards, Dr. Attaman

  27. John H
    John HSep 20, 2016

    Good information. Gathering info for my wife who has phn ongoing for two months. Need a referral for phn treatment in Denver Colorado.

  28. Sandra
    SandraSep 30, 2016

    Would you please reccomend a Doctor that can do this procedure in Southern California or California. We would be willing to travel to try this procedure as the pain is very intense and has been going on for years. Thank you

  29. Gary B
    Gary BNov 01, 2016

    Have Shingle pain for four months, need referred to nearby Doctor near or in Corpus Christi, Tx
    To do procedure to block pain, Intercostal nerve block or something.

  30. Lee
    LeeNov 27, 2016

    Dr. Attaman,

    My mom was recently diagnosed with Shingles and has already started noticing symptoms of PHN. Can you recommend someone in Las Vegas that can do an assessment and determine if Intercostal Nerve Block is an option?

  31. Arie E
    Arie EDec 20, 2016

    My wife is in her third week of a very painful Shingles episode. She is not responding to 2 sets of drugs (300mg/day Lyrica is the latest).
    We live in the Washington Baltimore area. Can you recommend a physician on the east coast who performs your type of procedure? thanks,

  32. George A
    George AJan 14, 2017

    Do you know of a doctor in Virginia or North Carolina who performs this procedure ? Intercostal Nerve Block for Shingles Pain/Post-herpetic Neuralgia Pain. I got shingles almost 2 yrs ago and tried several different treatments. Nothing has worked.

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRJun 08, 2017

      Dear George,

      I do not know of any personally, but I’m sure there are many in your region that can do this. I suggest you find an Interventional Pain Management specialist. Kind Regards, Dr. Attaman

  33. Ruth H
    Ruth HFeb 01, 2017

    I have had pain since shingles in January of 2016. It is unbearable at times. Is there a Dr. in Tyler, Texas that might help?
    My primary physician does not give me much hope of this going away since it has been going on for over a year.

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRJun 08, 2017

      Dear Ruth,

      I’m sorry you are in pain. There are many pain doctors in your area. I’d suggest going to Texas Tech Pain Clinic. They have many excellent pain doctors there. Kind Regards, Dr. Attaman

  34. Marilsa W
    Marilsa WFeb 17, 2017

    Dr. Attaman

    I am from Fort Lauderdale, FL. My mother has suffered from PHN for 3 years now. We have tried everything except for this nerve block. I am running low on fuel, I can’t ke seeing my mom like this. She can’t sleep at night, I find her crying almost every night. We need HELP! My mom is 71 years old and has gone through a successful kidney transplant that my sister donated to her. This can’t be the end of her. Would we need a referral to see you in Seattle?

    • Jason G. Attaman, DO, FAAPMR
      Jason G. Attaman, DO, FAAPMRJun 08, 2017

      Dear Marilsa,

      I’m sorry to hear about your Mom. You should look for a Pain Management specialist in your area who can do this nerve block. Almost all major hospitals and university medical centers have such specialists. Kind Regards, Dr. Attaman

  35. Beverly
    BeverlyJul 06, 2017

    Could you please tell me if there are any doctors you could refer in Dallas, Texas? I too have PHN and the pain has become unbearable. I feel like life as I knew it before this is over. Very frustrating and depressing. Thank you.

  36. Tyrone Flanagan
    Tyrone FlanaganSep 15, 2018

    Dr. Attaman, I have shingles PHN pain in the facial area. Can you recommend a good pain doctor in the central coast area of California? I’ve had a C3 nerve block
    done that had very little effect. Thank you so much.

  37. vern johnson
    vern johnsonSep 20, 2018

    got shingles july 21 2018 ever since I have the stabbing pain very painful. gone through 4 boxes of lidocaine patches. went to a neurologist and he said shot would help me. but is sending me to a pain dr,ghuman here in las vegas for the shot. do you think I should ask him about the intercostal nerve block. thank you so much

  38. Millie Hue
    Millie HueMar 21, 2019

    Thanks for pointing out that there is a treatment that you can get which has been proven to alleviate pain for 90% of the cases while ensuring that it will last. I will suggest this to my sister since she has this issue with her neck ever since she got into a car accident. She might have developed chronic pain after having whiplash since the pain has last for months now.

  39. R3 Stem Cell
    R3 Stem CellAug 03, 2020

    Thank you James for pointing at right direction and sharing that treatment is available, but individuals just need to look at right place.

  40. Marcia Bixby
    Marcia BixbyOct 18, 2021

    Have PHN, will be 5 months since rash. Burning sensation above eye (forehead) with painful area in scalp. Recommendation for clinic in Chicago, IL area. I’m in the NW suburbs. Thank-you.

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