Evidence for interventional procedures as an adjunct therapy in the treatment of shingles pain

To enhance the learner's competence with knowledge of interventional procedures as an adjunct therapy in the treatment of shingles pain.

This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.

After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of active herpes zoster (HZ) symptoms, antiviral therapy criteria, non-interventional medication management for HZ-related symptoms, and HZ-related complications including post-herpetic neuralgia (PHN).2. Apply knowledge of PHN interventional procedures to examples of patient care case scenarios.

Shingles (herpes zoster) is a painful manifestation of infection of the dorsal root ganglia of the spine and seen as blisters or vesicles in linear formation, usually on the upper torso. Up to one-third of those afflicted will experience complications, with the most common complication being postherpetic neuralgia (PHN). The risk of PHN increases for each decade of life after age 50 years, and the pain associated with this complication has the potential to endure for years, be unrelenting, and decrease an individual's quality of life. Treatment options, including adjunct interventional procedures, are presented to address the common complication of PHN. Although no conclusive evidence base is present for the use of any particular interventional procedure in the treatment of acute pain or refractory pain of shingles, a number of therapies have been indicated to have some level of effectiveness. Standard therapy options in the form of oral medications and topical agents should be used first. For those situations of refractory pain, a referral to an interventional pain management specialist is warranted to explore possible adjunct procedures to lessen the pain of PHN. A comprehensive care management approach, incorporating interventional pain management procedures as an adjunct therapy, will enable patients to have their pain treated as effectively as possible by utilizing appropriate methods available.