Background <p>Postherpetic neuralgia (PHN) represents the most prevalent and distressing complication of shingles. The aim of this study was to explore the diagnostic significance of miR-34c-5p in PHN patients and to assess its correlation with rehabilitation effect.</p> Methods <p>This study enrolled 154 PHN patients and 108 healthy participants as research subjects. RT-qPCR was used to detect serum miR-34c-5p levels in the participants. ROC curve was employed to estimate the diagnostic significance of miR-34c-5p in PHN patients. Logistic regression analysis was performed to analyze the risk factors related to the occurrence of PHN. VAS, TEX-Q and HADS scales were filled in by questionnaires to analyze the rehabilitation effect of PHN patients after treatment. Spearman correlation analysis was applied to evaluate the relationship of miR-34c-5p levels with rehabilitation effect in treated PHN patients.</p> Results <p>miR-34c-5p levels were notably elevated in PHN patients compared to healthy participants. miR-34c-5 had a high sensitivity (79.2%) and specificity (84.3%) to distinguish between healthy individuals and PHN patients. Logistic regression analysis indicated that miR-34c-5p emerged as an independent risk factor for the development of PHN. miR-34c-5p levels, VAS, TEX-Q, HADS-A and HADS-D scores were reduced in prednisone-treated PHN patients compared to the basic treatment group. In addition, Spearman correlation suggested that miR-34c-5p levels were positively correlated with VAS, TEX-Q, HADS-A and HADS-D scores.</p> Conclusion <p>miR-34c-5p exhibited the ability to diagnose PHN and may be a biomarker for diagnosis of this disease. Moreover, reduced miR-34c-5p expression in PHN patients correlate with enhanced outcomes in rehabilitation.</p>