Ouch indeed! I've had them twice, which, was believed to be impossible,
but they were never severe.

I don't want to be alarming, but an active outbreak with substantial
pain needs to be treated aggressively to prevent permanent pain.  The
direct treatment should include an anti-herpes drug such as vancyclovir
or acyclovir, and, although I'd check if this is still preferred, fairly
high dosage corticosteroids.

Pain management for shingles shouldn't rely only on standard
painkillers. Remember that the infection is actually in a nerve, so pain
relief has to involve desensitizing that nerve. She can certainly have
traditional pain relievers, but she definitely should be taking an
anticonvulsant effective against nerve pain, such as gabapentin
(Neurontin) or carbemazepine (Tegritol).

As soon as her skin can tolerate it, she should also be applying
capsaicin cream.  This is the active principle in chile peppers, but is
an extremely effective treatment for postherpetic neuralgia -- and also
for quite a few other pain syndromes when the cause of the pain is near
the surface of the skin, such as arthritis. Capsaicin burns when first
applied, and the skin has to get used to it, especially before using
full strength.

Once the skin tolerates it -- I can now use it anytime -- it triggers
the release of a pain-transmitting chemical, Substance P. If the
capsaicin is applied often enough, it depletes the supply of Substance P
in the nerve, often without it letting the pain signal propagate.
Continued use of the cream seems to train the nerve to maintain a lower
supply and have less ability to transmit pain.

If a primary physician can't properly treat this, it's a tossup whether
to go to a dermatologist or neurologist. The latter will be better if
there is residual pain, but the object of treatment should be avoiding
the residual pain syndrome, called postherpetic neuralgia.