Herpes zoster (HZ) afflicts millions of older adults annually and causes significant suffering from acute and chronic pain, or postherpetic neuralgia (PHN). HZ is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia in the setting of age, disease, and drug-related decline in cellular immunity. VZV-induced neuronal destruction and inflammation cause the pain, interference with activities of daily living, and reduced quality of life. The optimal treatment of HZ requires early antiviral therapy and pain management. For PHN, evidence-based pharmacotherapy can reduce pain burden. The zoster vaccine is effective in reducing pain burden and preventing HZ and PHN in older adults.