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Why you should read this article: • To understand the causes of peripheral neuropathic pain and its effects on patients’ quality of life • To be aware of the non-pharmacological interventions that may be used to manage peripheral neuropathic pain • To consider how you could support patients to self-manage their peripheral neuropathic pain. Peripheral neuropathic pain is a complex condition that can adversely affect people’s quality of life. Alongside pharmacological interventions, nurses can support patients to self-manage their pain using non-pharmacological interventions such as lifestyle changes and exercise. To do this effectively, nurses should be able to recognise the signs and symptoms of peripheral neuropathic pain and be able to educate patients on appropriate self-management approaches. It is important that nurses provide education, advice and information in a way that patients can understand and check this understanding. This article provides an overview of how nurses can support patients to self-manage peripheral neuropathic pain by using various non-pharmacological interventions. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the causes and characteristics of neuropathic pain • To increase your knowledge of the physiology and types of neuropathic pain • To recognise the importance of undertaking a holistic assessment of neuropathic pain Neuropathic pain results from damage to the nerves. It affects many in the general population, but its prevalence is higher in certain groups, for example those who have undergone certain procedures or systemic anti-cancer therapy and people with conditions such as diabetes mellitus, viral infections or central nervous system disorders. Regardless of the cause, neuropathic pain can have significant adverse effects on people's quality of life, so nurses need to be able to conduct a holistic pain assessment that incorporates physical, emotional, social and spiritual aspects. This article explores the prevalence, characteristics and nursing assessment of neuropathic pain with the aim of improving nurses' awareness, practice and care of people affected by this type of pain. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the principles of pain assessment and management • To identify useful pain assessment and management tools and resources • To enhance your awareness of the adverse effects and complications of opioids Pain is a distressing, subjective and complex phenomenon that all nurses will encounter in their clinical practice. Effective pain management requires nurses to undertake a structured assessment to identify the probable causes of pain and guide management. Interventions used to reduce pain can be varied and multimodal. This article provides an overview of pain including its definition, classifications, assessment and management. It emphasises the importance of a person-centred approach to care which reflects Margo McCaffery's seminal quote that pain is 'whatever the experiencing person says it is'. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the association between neuropathic pain and high-risk alcohol use • To learn how chronic pain can develop on withdrawal from alcohol • To familiarise yourself with the concept that previous medically assisted detoxification may increase the risk of neuropathic pain Background: High-risk alcohol use is correlated with chronic pain. Chronic pain and alcohol dependence are associated with similar neurological, endocrinological and behavioural patterns, and it has been hypothesised that symptoms of neuropathic pain are exacerbated following alcohol withdrawal. Aim: To investigate the presence of neuropathic pain upon withdrawal from alcohol, in people with high-risk alcohol use with or without a history of medically assisted detoxification. Method: A small observational cross-sectional study investigated the presence of neuropathic pain in two groups of hospitalised adults exhibiting high-risk alcohol use: one group with a history of medically assisted detoxification, the other group with no history of medically assisted detoxification. Results: The results provided some evidence that neuropathic pain is more likely to be experienced by people with high-risk alcohol use who have previously undergone medically assisted detoxification. Conclusion: Understanding that previous medically assisted detoxification may increase the risk of neuropathic pain means that nurses can improve their preparation when assessing, monitoring and managing neuropathic pain in people recovering from high-risk alcohol use. Nurses will be able to direct patients recovering from high-risk alcohol use to available pain management support in a timely manner, for example a local pain clinic, possibly even before detoxification. This is important given the links between pain, relapse into alcohol use and addiction to analgesics. [ABSTRACT FROM AUTHOR]

Chest pain is a common reason for patient presentation to emergency departments and visits to primary care settings. While most causes of chest pain are not life-threatening, a small proportion require urgent intervention, particularly cardiac conditions such as acute coronary syndrome. Therefore, it is essential for healthcare practitioners, including nurses, to identify the cause of chest pain in a safe, timely and effective manner. This article outlines the main causes of chest pain and describes the aspects of chest pain assessment, including patient history-taking, physical examination and clinical investigations. Assessing chest pain requires healthcare practitioners to have knowledge of its causes and pathophysiology, the use of structured assessment tools and the latest evidence-based guidelines. [ABSTRACT FROM AUTHOR]

The British Pain Society (BPS) defines pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage'. [ABSTRACT FROM AUTHOR]

This article discusses herpes zoster (HZ) and postherpetic neuralgia (PHN). Particular focus is given to the prevalence of shingles infection in the U.S., along with its incidence and pathophysiology. Symptoms associated with shingles include pain in the dermatome where subsequent lesions will develop, headache, malaise, fever, chills and gastrointestinal disturbances. Treatment options include antiviral drugs, analgesia, and glucocorticoids. Also included are recomendations for zoster vaccination and the pharmacists' role in vaccination.

This article provides an overview of the management of post-herpetic neuralgia (PHN)--a debilitating nerve pain that continues after the herpes zoster (shingles) rash has cleared. PHN mainly affects older people and although there are a number of treatment options available, drug interactions and side effects frequently limit their use. Nurses need to demonstrate an understanding of the difficulties associated with the management of PHN to provide safe and effective pain relief and to improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

The author discusses some important issues for nurses to put in mind when helping patients alleviate pain. The author noted that helping patients to identify their pain and its triggers is the first step in alleviating it. Nurses need to work with the patient to carefully unpick what their pain is. The author said that nursing staff play an important role in identifying and alleviating pain, which is more difficult to do when the nervous system becomes damaged or is not functioning as usual.

The article discusses the different ocular disorders corneal neuropathic pain and nociceptive pain that can occur concomitantly in patients. Topics covered include the syndromes' different causes of an insult to the nervous system, and of noxious stimuli, their manifestations of dry, burning and aching eyes in patients which can possibly come from without the ocular surface, and the diagnostic approach to distinguish the two disorders. Also noted are clues for recognizing their risk factors.

The article discusses a study by Dr. Ann V. Quan of the University of Miami Hospital that investigated the efficacy of nerve block to treat the neuropathic components of ocular pain. Review of 11 patients treated with standard injectable solution of bupivacaine for ocular pain from varying etiologies showed 7 patients reporting immediate pain relief, the longest period being 7 months. It concludes that nerve blocks can successfully treat chronic ocular pain from a variety of causes.

The article discusses the diagnosis of dry eye syndrome, as well as the possible treatments. Also cited are the comment by Dr. Deborah S. Jacobs of Harvard Medical School on dry eye syndrome, the research conducted by Dr. Carlos Belmonte of the Instituto de Neuroscienias (UMH-CSIC) on the disease, and the effectiveness of confocal microscopy in diagnosing the disease.

The article discusses the clinical management of postherpetic neuralgia (PHN), a pain that persists for more than three months following the healing of herpes zoster. The pain associated with PHN is said to negatively affect mood, sleep and quality of life. A discussion on the use of gabapentin to manage PHN is presented, including the challenges associated with gabapentin treatment. The article also considers a study on the safety and efficacy of GRALISE gabapentin in patients with PHN.

The article focuses on the role of vaccines in preventing corneal and external ocular diseases. During the annual meeting of the American Society of Cataract and Refractive Surgery, physician Minas T. Coroneo discussed the benefits of vaccines in preventing herpes zoster virus and human papilloma virus. The Shingles prevention Study has also revealed that vaccines can reduce the possibility of post-herpetic neuralgia.

The article discusses the signs and symptoms of, causes and risk factors for and treatments which are available for neuropathic pain. A discussion of the ways in which nurses can help patients with neuropathic pain, and of resources which offer additional information on neuropathic pain, is presented.

The article discusses research by Sinéad Langan of the faculty of epidemiology and population health at the London School of Hygiene and Tropical Medicine and colleagues which revealed that herpes zoster vaccination reduced the incidence of zoster and postherpetic neuralgia.

The article reports on the approval of the government agency Food and Drug Administration (FDA) of the gabapentin enacarbil for the management of postheripetic neuralgia that follows the healing of herpes zoster.

The article discusses the results of a national survey by the American Pain Foundation (APF) which indicate that most Americans are unaware of the risks and symptoms of postherpetic neuralgia (PHN) or after-shingles pain.

The article deals with a study that examined the association between higher antibody titers and increased herpes zoster severity and incidence of post-herpetic neuralgia.

The article reports on a recommendation from the U.S. Centers for Disease Control on the use of the herpes zoster vaccine for older adults who have herpes zoste or shingles. It is noted that the incidence and severity of herpes zoster increases with advancing age and its complications include postherpetic neuralgia. The only available vaccine to prevent herpes zoster is Zostavax from Merck & Co. Inc.

A quiz concerning post-herpetic neuralgia is presented. INSET: HOW TO USE THIS ASSESSMENT.

The article reports on the off-label use of botulinum toxin type A (Botox) for refractory headache. Botox is prescribed by physicians for the treatment of acute or chronic tension-type headaches, cervicogenic headaches and chronic migraine headaches. Patients with severe occipital neuralgia underwent occipital nerve blocks using 50 units of Botox for each block and significant improvements were shown in the visual analogue scale and Pain Disability Index.

Discusses a study in the "New England Journal of Medicine" which showed that vaccination against varicella zoster virus (VZV) can markedly reduce the incidence of and morbidity from herpes zoster and postherpetic neuralgia among older adults. Clinical trials conducted by researchers from the Shingles Prevention Study Group, a cooperative study from the Department of Veterans Affairs in collaboration with the National Institute of Allergy and Infectious Diseases and with Merck; Merck's investigational new drug application on the vaccine used in the study.

The article presents answers to queries on managing post-herpetic neuralgia. In reply to a question, Dr. H.S. Ghazi- Birry, 6D of the Southern College of Optometry in Memphis, Pennsylvania, says to start with 300mg of the anti-epileptic Neurontin once a day on day one, twice a day on day two and three times a day on day three. If the Neurontin is ultimately ineffective, he would prescribe Trileptal (oxcarbazepine, Novartis) or Keppra (levetiracetam, UCB Phartna) for a few weeks. He adds that he would also have the patient use either a topical 5% lidocaine gel and topical lidocaine patch or employ capsaicin cream to the affected area.

The article focuses on a man who suffered an attack of shingles in days when antiviral treatments were not available. Antiviral treatments such as Zovirax were not available at that time. The large scab that had developed eventually dropped off and he fortunately did not develop any sequelae such as postherpetic neuralgia. His nose was spared from blisters, as was his cornea. INSET: Claim £30.