Objective To explore the risk factors of pain in patients with herpes zoster after acute stage （1 month after onset）. Methods The patients with herpes zoster who visited the Department of Dermatology Xuanwu Hospital of Capital Medical University from November 2020 to April 2021 were selected as the research objects. The general data of patients were recorded， and the scores of Visual Analogue Scale （VAS）， Generalized Anxiety Disorder （GAD-2）， Patient Health Questionaire-2 （PHQ-2） and Pittsburgh Sleep Quality Index （PSQI） were evaluated at the initial diagnosis （onset） and follow-up （1 month after onset）. Univariate analysis and dichotomous Logistic regression analysis were applied to explore the high-risk factors for the occurrence of post-acute pain. Results A total of 235 patients were enrolled， including 102 males and 133 females. The onset age was （52.59±16.30） years old. Pain was present in 29.8% （70/235） of patients 1 month after onset. Univariate analysis showed that onset age， chronic disease， VAS score at initial diagnosis， GAD-2 and PHQ-2 score at follow-up， and sleep disorder after onset were the influencing factors of post acute pain in patients with herpes zoster （P ＜ 0.05）. The binary Logistic regression analysis showed that onset age ≥ 50 years old （P=0.005， OR=3.919， 95%CI：1.520-10.106）， VAS score ≥ 4 points at the initial diagnosis （P=0.016， OR=3.735， 95%CI：1.277-10.929）， GAD-2 score after onset （P=0.001， OR=3.944， 95%CI：1.817-8.562）， and 1 score of sleep persistence after onset （P=0.008， OR=7.569， 95%CI：1.699-33.725） were the risk factors for pain after acute stage. Conclusions The risk factors of post-acute herpetic neuralgia in patients are age ≥ 50 years old，pain with moderate or above at the time of initial diagnosis， anxiety state after onset and poor sleep persistence. Clinical attention should be paid to the anxiety state and sleep status of patients with herpes zoster.