HS Pain Relief: Managing Hidradenitis Suppurativa Pain

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HS Treatment Options: Complete Guide

A full overview of every HS treatment, from topical medications and antibiotics to biologics and surgical options.

Pain is one of the most debilitating aspects of hidradenitis suppurativa. Studies consistently rank HS among the most painful chronic skin conditions, with many patients experiencing pain that interferes with sleep, work, relationships, and basic daily activities. Yet HS pain is frequently dismissed, undertreated, or simply not addressed in clinical appointments.

You deserve effective pain management. This guide will help you understand the different types of HS pain, the full range of treatment options, and how to advocate for yourself with your healthcare team.

Seek emergency care if you have severe pain with fever, rapidly spreading redness, or signs of sepsis (confusion, rapid heart rate, difficulty breathing).

Understanding the Types of HS Pain

HS produces several distinct types of pain, each requiring different management approaches. Identifying which type you are experiencing helps you and your doctor choose the right treatment.

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Acute Flare Pain

Intense, localized pain during an active abscess or nodule. Often described as throbbing, burning, or stabbing. Peaks before a lesion ruptures.

Severity: Severe

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Chronic Background Pain

Persistent low-to-moderate pain between flares from scar tissue, nerve damage, and ongoing inflammation. Often underreported and undertreated.

Severity: Moderate

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Neuropathic Pain

Burning, shooting, or electric-shock sensations caused by nerve damage from chronic inflammation and scarring. May persist even when active lesions are absent.

Severity: Variable

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Movement-Related Pain

Pain triggered by movement in areas with scar tissue, particularly in the armpits and groin. Can significantly limit mobility and daily function.

Severity: Moderate–Severe

Immediate Pain Relief Strategies

Warm Compress

Apply a warm (not hot) compress for 10–15 minutes. Heat increases blood flow, can help bring an abscess to a head, and provides temporary pain relief. Repeat 3–4 times daily during a flare.

OTC NSAIDs

Ibuprofen (400–600mg) or naproxen (220mg) taken with food. NSAIDs address both pain and inflammation. More effective for HS than acetaminophen alone.

Topical Lidocaine

OTC lidocaine gel (4%) applied to accessible lesions provides temporary local numbing. Useful before dressing changes or other painful wound care procedures.

Ice vs. Heat

Heat is generally preferred for HS (helps abscesses drain). Ice may help with post-procedure pain or swelling. Never apply ice directly to open wounds or broken skin.

Positioning

Elevate the affected area when possible. Avoid positions that put direct pressure on lesions. Specialized cushions or pillows can help with groin or buttock lesions.

Loose Clothing

Tight clothing increases friction and pain. Switch to loose-fitting, soft fabrics immediately during a flare. Seamless underwear and soft bras can make a significant difference.

Prescription Pain Management Options

If OTC medications are not providing adequate relief, speak with your doctor about prescription options. Pain management for HS should be part of your overall treatment plan, not an afterthought.

Medication Class	Examples	Best For
Prescription NSAIDs	Celecoxib, diclofenac	Acute and chronic inflammatory pain
Corticosteroid injection	Triamcinolone (intralesional)	Acute nodule/abscess, fastest relief
Gabapentinoids	Gabapentin, pregabalin	Neuropathic/burning pain
Low-dose naltrexone (LDN)	Naltrexone 1.5–4.5mg	Chronic pain + anti-inflammatory effect
Tricyclic antidepressants	Amitriptyline, nortriptyline	Chronic pain + sleep disruption
SNRIs	Duloxetine	Chronic pain + depression/anxiety
Topical anesthetics	EMLA cream, lidocaine patches	Localized surface pain

Non-Drug Pain Management

Complementary approaches can meaningfully reduce HS pain and improve quality of life, particularly for chronic background pain.

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Mindfulness-Based Stress Reduction (MBSR)

Mindfulness meditation has strong evidence for reducing chronic pain perception. Apps like Headspace and Calm offer guided programs. Even 10 minutes daily can make a difference.

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Cognitive Behavioral Therapy (CBT)

CBT for chronic pain helps reframe pain catastrophizing and develop coping strategies. Particularly effective when combined with medical treatment.

Moderate

Gentle Movement and Stretching

Low-impact movement (swimming, yoga, gentle stretching) can reduce chronic pain and improve mobility. Avoid high-impact activities during active flares.

Moderate

Dietary Anti-Inflammatory Approaches

Reducing inflammatory foods (dairy, high-glycemic foods) may reduce overall inflammation and pain. See our full guide on HS diet and inflammation.

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Heat Therapy (Infrared)

Far-infrared saunas and heating pads have shown benefit for chronic pain conditions. Gentle heat can reduce muscle tension around affected areas.

Frequently Asked Questions

How painful is hidradenitis suppurativa?

HS pain is often described as among the most severe chronic pain conditions. Studies have found that HS patients report pain levels comparable to those with rheumatoid arthritis, and many describe individual flares as more painful than childbirth. The pain is not just physical, it is chronic, unpredictable, and profoundly impacts mental health and quality of life.

What is the best over-the-counter pain relief for HS?

NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) are the most effective OTC options because they address both pain and inflammation. Take with food to protect the stomach. Acetaminophen (Tylenol) helps with pain but does not reduce inflammation. Topical lidocaine gels can provide temporary local numbing for accessible lesions.

What prescription pain medications are used for HS?

Depending on severity, doctors may prescribe stronger NSAIDs (celecoxib, diclofenac), gabapentinoids (gabapentin, pregabalin) for neuropathic pain, low-dose naltrexone (LDN) which has shown promise in HS, tricyclic antidepressants (amitriptyline) for chronic pain management, or in severe cases, short courses of opioids during acute flares. Discuss your pain management needs openly with your doctor.

Can CBD or cannabis help with HS pain?

Some HS patients report significant pain relief with CBD oil or medical cannabis, and there is growing anecdotal evidence. Limited clinical research exists specifically for HS, but cannabinoids have demonstrated anti-inflammatory and analgesic properties in other chronic pain conditions. If you are in a jurisdiction where medical cannabis is legal, discuss this option with your doctor.

How do I manage HS pain at night?

Nighttime HS pain is particularly disruptive. Strategies include: elevating the affected area with pillows to reduce pressure, using a cooling gel pad or warm compress depending on what provides relief, taking pain medication 30–60 minutes before bed, using silk or satin sheets to reduce friction, and practicing relaxation techniques (deep breathing, progressive muscle relaxation) to help your nervous system downregulate.

Is HS pain considered a disability?

In many countries, severe HS can qualify as a disability under relevant legislation (ADA in the US, Equality Act in the UK). If HS substantially limits your ability to work or perform major life activities, you may be entitled to workplace accommodations. Consult with a disability rights attorney or patient advocacy organization for guidance specific to your situation.