Question

Case Scenario: A 72- year old woman presents with shingles. The blisters began near her spine and have continued around her rib cage. She is in pain and states nothing helps. She is the primary care giver for her aging mother and a grandson.

Question: Make a starting treatment plan for this patient. Support your answer using specific facts, data, examples, and other information drawn from the textbook

Answer 1

Prompt treatment with prescription antiviral drugs can speed healing and reduce the risk of complications associated with shingles. Other than this taking a cool bath or using cool, wet compresses on the blisters may help relieve the itching and pain.

Starting treatment plan includes

Antiviral agents

This will help to decrease the duration of herpes zoster rash and the severity of pain associated with the rash. However, these benefits have only been demonstrated in patients who received antiviral agents within 72 hours after the onset of rash. Antiviral agents may be beneficial as long as new lesions are actively being formed, but they are unlikely to be helpful after lesions have crusted. Antiviral agents include Acyclovir, Valacyclovir, Famciclovir etc

Corticosteroids

Orally administered corticosteroids are commonly used in the treatment of herpes zoster, even though clinical trials have shown variable results. Prednisolone used in conjunction with acyclovir has been shown to reduce the pain associated with herpes zoster. The likely mechanism involves decreasing the degree of neuritis caused by active infection and possibly decreasing residual damage to affected nerves. some studies designed to evaluate the effectiveness of prednisolone therapy in preventing postherpetic neuralgia have shown decreased pain at three and twelve months .

Analgesics

Mild to moderate pain can be treated with over-the-counter analgesics. However, patients with severe pain may require narcotic medications. Topically administered lidocaine and nerve blocks have also been reported to be effective in reducing pain.

Tricyclic antidepressants can be effective adjuncts in reducing the neuropathic pain of postherpetic neuralgia. These agents most likely lessen pain by inhibiting the reuptake of serotonin and nonepinephrine neurotransmitters. The most commonly used medications include amitriptyline, nortriptyline, imipramine, desipramine etc.

Anticonvulsants like phynitoin, carbamazepine and gabapentin are also often used to control neuropathic pain.