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This chapter outlines the best current therapy of post-herpetic neuralgia (PHN) and herpes zoster (HZ) and the exciting promise of the zoster prevention vaccine. The clinical findings, on examining a patient with PHN, demonstrate three main features to the pain. There is a constant, steady burning pain, electric shock-like pains reminiscent of trigeminal neuralgia, and the skin is often very sensitive or painful to summating touch stimuli such as skin stroking. There are three possible approaches to managing PHN: the treatment of established PHN, the prevention of PHN by early and aggressive treatment of HZ, and the prevention of HZ and PHN by vaccination. Drugs such as Tricyclic antidepressants (TCAs), gabapentinoids, and opioids affect all features of the pain. An important question for clinicians is how satisfactory these drugs are for PHN patients in ordinary practice in terms of pain relief and disability, tolerability of side effects, and long-term benefit.
Pain management is an essential part of clinical practice for all healthcare providers from trainees, physician assistants and nurse practitioners through to practising physicians. Problem-Based Pain Management is a collaboration between experts in anesthesiology, geriatric medicine, neurology, psychiatry and rehabilitation which presents a multidisciplinary management strategy. Over 60 chapters follow a standard, easy-to-read, quick access format on: clinical presentation, signs and symptoms, lab tests, imaging studies, differential diagnosis, pharmacotherapy, non-pharmacologic approach, interventional procedure, follow-up and prognosis. The broad spectrum of topics include headache, neck and back pain, bursitis, phantom limb pain, sickle cell disease and palliative care. Unlike other large, cumbersome texts currently available, this book serves as a quick, concise and pertinent reference in the diagnosis and management of common pain syndromes.