DEAR DR. ROACH: Is there anything that I can do for pain after having shingles? I had shingles 18 months ago, and I still have pain on my right side in my breast and arm. I took gabapentin, plus two other prescriptions, and they all upset my stomach so bad that I had to quit. I have used lidocaine patches, but they help very little.

Some days, it is worse than others, and no one seems to have any answers. If I lie still with my arm to my side, it does let up, but as soon as I move, it hurts … even when I lift my arm to do anything. — R.

ANSWER: Pain after shingles, called post-herpetic neuralgia (PHN), can be extremely painful and difficult to treat. Even experts often have to try many different combinations of medications to treat the pain, and the results are not always satisfactory.

Shingles directly damages the nerves, and the pain during a shingles outbreak can be very bad. But some people continue to have pain for weeks, months or even years after the outbreak. In most people, the pain eventually resolves. The older a person is, the longer the pain of PHN tends to last, and unfortunately, in some people, it never goes away.

Gabapentin and the closely related pregabalin are effective drugs for many people. Another class, called the tricyclic antidepressants, are also useful. There are many different ones, and it can take some tries before finding one that is effective without too many side effects. Experts in pain management will often try additional drug classes, such as anti-seizure drugs and other anti-depression drugs like duloxetine.

It’s far, far better to prevent post-herpetic neuralgia than it is to treat it. I strongly recommend for people over 50 to get the new, highly effective vaccine against shingles (Shingrix), even if you already had the old single-dose vaccine (Zostrix) or had shingles in the past.

DEAR DR. ROACH: I have a question about professional medical ethics for you. I certainly do not want to insult my endocrinologist. But I do think she should know that I went for another opinion from a doctor at a specialty hospital for treatment of my osteoporosis. This expert suggested a few things for me to consider that my regular endocrinologist never mentioned. How do patients broach this with you? — R.C.

ANSWER: As a primary care doctor, I routinely hear that the specialist recommended treatments I did not, but specialists are supposed to have a higher level of expertise than I do: That’s why I refer my patients to experts! It’s a little different when it’s a physician with the same area of expertise.

In my experience, the best approach is to be very direct, something along the lines of: “I wanted a second opinion and was recommended these other treatments. However, I value your judgment and want to know what you think about them.” It’s hard for a physician to get upset about that. In my opinion, it’s far more dangerous to your relationship with your doctor, and your medical care, to not say anything.

There is usually not one best way of treating a patient, and it often takes some time and back-and-forth between the patient and their doctor.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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