BACKGROUND: An epidural blockade has been considered a standard therapy for the management of pain in acute herpes zoster. However, it has many complications. Recently, we experienced good analgesia with a combination therapy including intravenous lidocaine infusion and intradermal injection of a local anesthetic and steroid in acute herpes zoster. Therefore, this study was performed to evaluate the necessity of an epidural steroid injection, added in a combination therapy, on the pain control of acute herpes zoster. METHODS: This retrospective study was based on the analysis of data of medical records. Forty-three patients suffering severe acute herpes zoster pain, were randomly divided into two groups. Intravenous lidocaine infusion (5 mg/kg) and an intradermal injection of lidocaine and a steroid into the wound were used twice a week in the Lidocaine group (n = 23), and in the Epidural group (n = 20), an epidural block with 0.5% lidocaine 6-8 ml with triamcinolone 30 mg was added once a week in addition to the above. We compared the efficacy of pain control using a pain relief scale (PRS) at 4 weeks after the initial visit to the pain clinic. RESULTS: Both groups were similarly managed in pain control. There were no statistical differences comparing the PRS between the two groups. CONCLUSIONS: Our results suggest that an epidural steroid injection, added in a combination therapy such as an intravenous lidocaine infusion and an intradermal injection of a local anesthetic and steroid, has no more advantages for the management of pain in acute herpes zoster. A further prospective study is recommended to compare the efficacy of pain control and the incidence of postherpetic neuralgia in a large number of acute herpes zoster patients.