Postherpetic neuralgia most often presents as a persistent pain that never subsides after an acute attack of shingles. The pain can cause great distress, especially in the elderly. Symptoms can be severe enough to interfere with sleep, appetite, or sexual function. Acute herpetic neuralgia is pain that begins before or accompanies the appearance of the rash and lasts up to 30 days from the onset of the attack. Subacute herpetic neuralgia is pain that persists after the rash has healed, but subsides within 4 months of the attack. Postherpetic neuralgia is pain that persists for more than 4 months from the start of the rash episode. There are 3 main types of pain: persistent burning pain, paroxysmal irritation, and pins-and-needles pain. It is often accompanied by areas of sensory loss and abnormal nociception, such as severe pain when wearing clothing and rubbing the skin. The thoracic nerve, the cervical nerve and the trigeminal nerve are most frequently involved. Trigeminal nerve involvement is also associated with headache, lacrimation, and eye pain. Postherpetic neuralgia is one of the intractable pains that plague the middle-aged and elderly population, lasting as short as 1 to 2 years or as long as 3 to 5 years or even more than 10 years if effective measures are not taken to control the pain. Clinical treatment is difficult, and patients suffer from chronic pain and depression, which seriously affects their quality of life and their ability to work and socialize is reduced or even lost. The American Academy of Neurology’s 2004 practice guidelines recommend the use of tricyclic antidepressants, gabapentin, pregabalin, opioids, and topical lidocaine patches as first-line treatment for postherpetic neuralgia (PHN). However, the long-term benefits of most drugs are uncertain and side effects are common, limiting medication adherence. In addition to medications, physical therapy, surgical treatment, nerve blocks and acupuncture, nerve destruction, and psychotherapy may be effective. For refractory postherpetic neuralgia, botulinum toxin type A injection therapy may be attempted. The application of botulinum toxin type A in the treatment of postherpetic neuralgia has been reported both at home and abroad, and the results of the studies have shown positive efficacy. In the first study, 60 patients were enrolled. Patients began to experience a reduction in pain 3-5 days after botulinum toxin type A injection, with a 4.5-point reduction in VAS pain score compared to the control group. In the second study, 30 patients were enrolled and 13 of them showed a significant effect (more than 50% reduction in pain), which was maintained for 16 weeks. Botulinum toxin type A for postherpetic neuralgia is generally safe, with mild and reversible side effects. The side effects of facial injections include facial asymmetry, stiffness of facial muscles, bruising and edema at the injection site.