BACKGROUND: Herpes zoster results from the reactivation of the varicella-zoster virus, which is often accompanied by a prodrome of dermatomal pain. Little is known about the burden of prodromal pain. OBJECTIVES: (1) Describe the frequency, severity and duration of prodromal pain; (2) determine the relationship between prodromal pain and the characteristics of herpes zoster at recruitment and the utilization of health care resources. METHODS: Between 10/2005 and 07/2006, 251 subjects ≥ 50 years old, seeking care for herpes zoster within 14 days of rash onset, were recruited across Canada. Severity and duration of prodromal pain were measured retrospectively using the Initial Zoster Impact Questionnaire. The burden of prodromal pain was obtained by the product of pain severity and duration. The severity of acute herpes zoster pain was measured using the Zoster Brief Pain Inventory. RESULTS: The majority of participants reported prodromal pain (74%). Mean pain duration and severity were 4.7 days and 6/10, respectively. Subjects aged 61-70 years old were more likely to report prodromal pain (RR=1.14, p-value=0.02). The burden of prodromal pain was greater in subjects not working (p-value=0.02) or immunosuppressed (p-value=0.04). Prodromal pain was associated with more severe acute pain (6.2 vs. 4.3, p-value 0.0001). Compared to subjects who did not report prodromal pain, those with this pain were more likely to receive antivirals (RR=1.18, p-value=0.04) and to visit the emergency room (RR=2.56, p-value=0.04). CONCLUSION: The burden of prodromal pain is significant and should be considered when evaluating the overall benefit of herpes zoster vaccination.