Subjective
Date of visit
Reason for visit (initial evaluation for suspected PHN, follow-up for diagnosed PHN)
History of present illness:
Onset and duration of pain following shingles rash (acute vs. established PHN)
Characteristics of pain (burning, stabbing, electric shock-like)
Location of pain (follows the dermatomal distribution of the affected nerve)
Severity of pain (impacting sleep, daily activities, quality of life)
Presence of allodynia (pain from light touch) or hyperalgesia (increased sensitivity to pain)
Use of pain medication and effectiveness
Past medical history of shingles, other relevant conditions
Social History
Impact of pain on work, social life, and emotional well-being
Stress levels (stress can worsen PHN)
Family History
Family history of shingles or PHN
Medications
Current medications (pain medications, antidepressants, anticonvulsants)
Dosage and frequency of pain medication
Allergies to medications (important for considering treatment options)
Objective
Vital signs (temperature, blood pressure) – may be normal unless there’s an underlying infection
Physical exam:
Neurological exam:
Assess for sensory abnormalities (allodynia, hyperalgesia) in the affected dermatome
Motor function examination (may be normal)
Skin exam:
Look for signs of shingles rash (if applicable) or healed shingles lesions
Assessment
Suspected PHN based on clinical presentation (pain characteristics, distribution) and history of shingles
Severity of PHN (mild, moderate, severe) – impacts treatment approach
Consideration of differential diagnoses (other nerve pain conditions)
Plan
Confirmation of PHN diagnosis (may not always be necessary based on clear history)
Treatment for PHN (aimed at pain relief and improving quality of life):
Topical medications (lidocaine patches, capsaicin cream)
Antidepressants (amitriptyline, nortriptyline) – commonly used for neuropathic pain
Anticonvulsants (gabapentin, pregabalin) – effective for some patients
Opioids (reserved for severe cases due to potential for addiction)
Nerve blocks (injections of anesthetic near affected nerves) – for short-term pain relief
Mind-body therapies (acupuncture, relaxation techniques) – may provide some benefit
Education
Explain postherpetic neuralgia, its causes, and the reasons why pain can persist after the rash resolves.
Discuss the importance of medication adherence and potential side effects of treatment options.
Non-pharmacological pain management strategies (stress management, relaxation techniques)
Importance of maintaining a healthy lifestyle (regular exercise, good sleep hygiene)
Follow-up
Schedule for follow-up appointments:
Monitor pain response to treatment and adjust medication regimen as needed
Assess for side effects and tolerability of medications
Address any emotional or psychological distress related to chronic pain
Consider referral to a pain specialist for complex cases or patients who are not responding well to initial treatment
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of postherpetic neuralgia.