From the Guidelines

Narcotics can help with herpes zoster (shingles) pain, specifically for post-herpetic neuralgia, a complication of acute herpes zoster infection.

Certain opioids, including oxycodone, extended-release morphine, and methadone, have been shown to be effective in managing post-herpetic neuralgia, with a number needed to treat (NNT) of 2.67 1.
Other treatments, such as gabapentin, tramadol, and pregabalin, have also been found to be effective, but may have a higher NNT compared to opioids 1.
The CDC clinical practice guideline for prescribing opioids for pain does not specifically address the use of opioids for herpes zoster pain, but does discuss the use of opioids for peripheral neuropathic pain, which includes pain related to herpes zoster 1.

Clinicians may consider a trial of pregabalin if patients have an inadequate response to gabapentin for post-herpetic neuralgia 1.
Topically administered lidocaine patches and capsaicin 0.075% may also be associated with analgesic efficacy, but these studies were limited by low numbers of patient episodes 1.

From the Research

Narcotics may be used for adequate pain control in patients with postherpetic neuralgia, a complication of herpes zoster 2.
Opioid analgesics are commonly used for pain relief in herpes zoster and postherpetic neuralgia, along with other treatments such as antivirals, steroids, and neural blockade with local anesthetics 3.
Opioids, anticonvulsants, tricyclic antidepressants, and topical treatment modalities may offer moderate pain relief to patients with postherpetic neuralgia, but may be associated with adverse events 4.
The use of opioids for pain management in herpes zoster patients is a significant concern, and prevention of herpes zoster through vaccination may be an effective strategy to reduce opioid prescriptions and related costs 5.
Treatment for acute herpetic pain, which is inflammatory and nociceptive, includes antiviral drugs, non-steroidal anti-inflammatory drugs, opioids, and sympathetic nerve blockade 6.

Postherpetic neuralgia, immunocompromised status, and comorbidities are main risk factors associated with opioid prescription in herpes zoster patients 5.
Patients with severe acute pain, older females, and those with a prodrome or severe rash are more likely to experience severe pain and may require narcotics for pain management 3.

Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are effective in reducing the severity and duration of acute herpes zoster when given within 72 hours of rash onset 2, 4.
Tricyclic antidepressants, gabapentin, pregabalin, and topical analgesics may be used to control neuropathic pain in postherpetic neuralgia 3, 4.
Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients for pain management 2, 4.