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The purpose of this article is to describe current knowledge and standards of care for postherpetic neuralgia (PHN) among older persons. Three influencing factors are considered: cultural implications, quality of life (QOL), and current practice of alternative/complementary therapy. A review of literature published between 2001 and 2006 was conducted. The findings indicate that PHN has debilitating effects on older adults regardless of culture. The impact of PHN on culture and ethnicity, particularly on the relationship between culture and patient's self-report of herpes zoster and/or PHN, has not been well investigated as evidenced in the literature. PHN is found to be associated with decreased health-related QOL among the elderly, with the most affected domains being sleep, mood, and general activity. Alternative and complementary therapy offers many advantages such as ease of use, availability, and low cost. However, due to lack of controlled trials and insufficient evidence, alternative therapy is not currently used widely and recommended. As the US population ages, the incidence of herpes zoster and PHN is expected to rise. Clinical trials that explore the response of the culturally diverse older adults to current treatment guidelines, strategies for prevention of PHN and its corresponding decrease in QOL, as well as controlled trials of alternative/complementary remedies should be considered.

Data Sources: Case example and review of clinical trials, meta-analyses, and reviews provide relevant data regarding the management of herpes zoster., Conclusions: Herpes zoster is a relatively common disease in elderly patients. It results from reactivation of varicella zoster virus (chickenpox). Characteristic vesicular lesions are often accompanied by significant acute pain. The risk of complications, such as postherpetic neuralgia (PHN), increases when patients age or are inadequately treated., Implications for Practice: Appropriate diagnosis and management of herpes zoster may shorten the overall disease course, accelerate cutaneous healing, and reduce the risk of PHN, a chronically painful complication. Greater understanding of the epidemiology, clinical manifestations, diagnosis, and available treatment options is essential for nurse practitioners and other primary care providers to initiate early treatment in patients with suspected herpes zoster infection.

Purpose: To discuss the impact of pain and its associated comorbidities in elderly patients with postherpetic neuralgia (PHN). To review the pharmacologic treatments available for patients with chronic pain and concurrent sleep disturbance, depression, and/or anxiety., Data Sources: Relevant clinical literature pertaining to the management of common comorbid conditions in patients with PHN and chronic pain syndromes., Conclusions: Chronic pain strongly influences physical and psychological function in elderly patients. Comorbid illnesses, such as insomnia, depression, or anxiety, often develop in patients with chronic pain and complicate overall pain management and worsen prognosis. Pharmacologic treatment strategies that reduce pain frequently result in concurrent improvements in common pain-associated comorbidities. Pharmacologic treatment should be selected based on the efficacy of the selected agent(s), potential for adverse effects, and impact on pain-associated comorbidity. A multidisciplinary pain care management approach is essential to alleviate pain, manage pain-associated comorbidities, and improve function and quality of life., Implications for Practice: Elderly patients who often deny their chronic pain are at increased risk for such conditions as sleep disturbance, depression, and/or anxiety. Nurses and nurse practitioners are in a unique position to improve pain care management by recognizing pain and its associated comorbidities early, educating patients regarding their perception of pain, and facilitating rational pharmacotherapy with the goal to improve function and quality of life.

Chronic pain may have devastating effects on the physical and psychological well being of many patients (Harden, 1999). Most community nurses are in contact with a number of patients with chronic pain and will be asked for advice and recommendations with regards to its management. Chronic neuropathic pain is a complex and sometimes intractable condition that patients will seek help for, from either GPs or from the community nursing teams. This article will examine one neuropathic pain syndrome - post-herpetic neuralgia - and review the evidence base in relation to treatment strategies, in an attempt to support community staff in the management of this difficult to treat pain syndrome.

Herpes zoster is an acute nervous system infection that commonly affects the elderly. Because the causative agent is a virus, herpes zoster is often treated symptomatically in the primary care setting. While this approach is acceptable for immunocompetent patients less than 50 years of age, it can leave older patients at greater risk of developing painful and debilitating complications such as postherpetic neuralgia. There is evidence that appropriate treatment initiated within 48 to 72 hours after the onset of the zoster eruption can decrease healing time, reduce acute pain, decrease ocular complications and may prevent the development of postherpetic neuralgia in this age group. The health care practitioner in a primary care setting is ideally placed to identify elderly clients with herpes zoster in the early stages; to consult with physicians about therapies such as steroids, antiviral agents and sympathetic nerve blocks; to monitor treatment effects; and to provide supportive therapy to those who develop postherpetic neuralgia.