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Acute and chronic pain account for high costs both societally and economically, estimated in the United States to be $635 billion. Untreated or undertreated acute pain is associated with substantial morbidity and may become chronic pain. Surgical patients are at an increased risk of long-term opioid use or addiction. Overdose from drugs of abuse, including opioids, is the leading cause of death due to injury in the United States. Traditional pain management strategies for acute and chronic pain have focused on opioid medications, which are often associated with severe side effects. Cryoneurolysis is a minimally invasive, nonsurgical, nonpharmacologic pain management technique that uses cold temperatures to ablate the sensory nerves that cause pain. Because of its safe and reversible nature, cryoneurolysis should be considered as part of a multimodal pain management plan in patients experiencing pain originating from sensory nerves., Competing Interests: The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article., (Copyright© by the American Association of Nurse Anesthetists.)

Background: Neuropathic pain (NP) is a common, severe problem that affects spinal cord injury (SCI) patients. Only SCI patients truly understand the impact and extent of this type of pain., Purpose: The aim of this study was to understand the NP experienced by SCI patients and the influence of this type of pain on their daily life., Method: A qualitative design was used. An interview guide including a semistructured questionnaire and in-depth interviews was conducted with SCI patients with NP in a neurorehabilitation department at a medical center in northern Taiwan. The data were collected using a purposive sampling method. Content analysis was performed on the interview data, which were obtained from 13 SCI patients with NP., Results: Three themes and eight subthemes were identified that described the NP experience of the participants and the influence of NP on their daily life. The three themes included elusive pain (changing and individual pain sensations, erratically haunting threat, and phantom limb sensations), complicated feelings about pain (converting depression into an active attitude toward life, having feelings of anticipation and anxiety about future pain relief, and facing and experiencing pain), and renewed hope (bravely fighting pain and seeking pain relief methods)., Conclusions: This study revealed three important themes of NP experienced by SCI patients, including elusive pain, complicated feelings about pain, and renewed hope. Nurses should understand the nature of NP, provide a thorough pain assessment, and design a proper pain management plan to care effectively for patients with NP.

Purpose/aims: The purpose of this study was to examine the management of patient's neuropathic pain with capsaicin 8% in a nurse-led clinic when administered by 1 registered advanced nurse practitioner without physician supervision., Design: A longitudinal, single-group, descriptive research design was used to assess pain scores and quality of life 3 times over 3 months after treatment., Methods: Patients with a diagnosis of neuropathic pain were assessed and treated with capsaicin 8% by 1 advanced nurse practitioner with prescriptive authority in a nurse-led clinic. Pain scores were collected at baseline, and self-assessed pain, activity level, and quality of life were assessed at 1 week, 4 weeks, and 3 months after treatment. Twenty-four patients were recruited, and data were analyzed using Friedman's test. In post hoc analysis, Wilcoxon signed-rank test was used with Bonferroni correction., Results: Pain scores differed from pretreatment to posttreatment at each of the 3 time points, at rest (χ3 = 20.54, P = .001) and on movement (χ3 = 23.644, P = .001), and remained significant after Bonferroni correction. Overall, 62.5% (n = 15) of patients achieved at least a 30% reduction in self-reported pain at rest from pretreatment to 3 months, and 54% (n = 13) achieved the same reduction in pain on movement. Most improvements in patient's quality of life occurred between 1 and 4 weeks. Patient satisfaction was high, with 83% stating that they would be happy to have the treatment repeated., Conclusion: Single-dose capsaicin 8% decreased neuropathic pain after being administered in an outpatient setting by an experienced registered advanced nurse practitioner. Further multicenter research led by advanced nurse practitioners is needed to support high-quality, safe treatment of neuropathic pain with high-concentration capsaicin in nurse-led chronic pain clinics.

Purpose: The purpose of the study was to measure the prevalence of acute neuropathic pain in patients with acute burn injuries and the demographic and clinical characteristics of neuropathic pain in this population. We also evaluated the proportion of patients who received twice-daily evaluation of nurses' documentation of neuropathic pain following introduction of a validated neuropathic pain assessment tool embedded within the pain chart., Design: Retrospective, descriptive study., Subjects and Setting: The sample comprised 86 patients with second- and third-degree burn injuries. The research setting was a burn injury unit in a provincial center in British Columbia, Canada., Methods: Medical records over a 1-year prior following introduction of assessment of neuropathic pain into pain charts were retrospectively reviewed, and data collection focused on evidence of nurses undertaking acute neuropathic pain assessment as well as prevalence of report of acute neuropathic pain signs among this patient group. Neuropathic pain was evaluated twice daily using the Douleur Neuropathique 4, a previously validated neuropathic pain assessment tool., Results: Eighty percent of patients cared for received twice-daily neuropathic pain assessment. The prevalence of patients with neuropathic pain based on the Douleur Neuropathique instrument scores was 42%. Males reported neuropathic signs more than female patients, and patients with a greater than 10% body surface burn had a higher prevalence of neuropathic pain., Conclusion: Study findings suggest that patients with acute burn injury are at risk of neuropathic pain. We recommend that nurse assessment of neuropathic pain becomes routine during the acute injury phase.

Occipital neuralgia is a headache resulting from dysfunction of the occipital nerves. Medically resistant occipital neuralgia is treated by greater occipital nerve injection, which is traditionally performed by neurologists. A nurse-led clinic was developed to try to improve the service. Patient feedback showed that the clinic was positively perceived by patients, with most stating the nurse-led model was more efficient than the previous one, which had been led by consultants.

Cancer pain can be nociceptive, neuropathic or mixed. It is linked to the tumour, to the metastases and to the treatments for the disease and is managed by multimodal analgesia corresponding to the pain relief drugs of the WHO's pain ladder, antidepressants, antiepileptic drugs and local anaesthetics., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Wound pain is often underestimated and poorly managed. This article explains the different types of pain and how to assess wound pain, and gives practical advice on how to manage or minimise the pain experienced by patients with wounds.

This study aimed to develop a grounded theory to describe and explain the experience of pain and its impact, as reported by the individuals who had pain associated with chronic leg ulceration. The Strauss and Corbin grounded theory approach was used. In-depth interviews were undertaken with 11 people aged ≥ 65 years from Leeds in the north of England. All participants were cared for by home care nurses and had painful leg ulceration. The emergent grounded theory centered on a core category of "The journey to chronic pain." The theory suggested a trajectory consisting of three phases that the patient experiences, where the end result is a chronic pain syndrome. In phase 1, leg ulcer pain has predominantly acute nociceptive properties, and if this is not managed effectively, or ulcers do not heal, persistent pain may develop with both nociceptive and neuropathic properties (i.e., phase 2). If phase 2 pain is not managed effectively, patients may then develop refractory long-term pain (phase 3). Those who progress to phase 3 tend to experience negative consequences such as insomnia, depression, and suicidal ideation. Only when health care professionals understand and acknowledge the persistent and long-term nature of the pain in this patient group can the pain be managed effectively., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Neuropathic pain (NP) in children with cancer is not well characterized. In a retrospective review of patient data from a 3.5-year period, we describe the prevalence of NP and the characteristics, duration of follow-up, and interventions provided for NP among patients referred to a pediatric oncology center's pain management service. Fifteen percent (66/439) of all referrals to our pain service were for NP (56/323 patients [17%]; 34 male, 22 female). The NP patient group had 1,401 clinical visits (778 inpatient visits [55.5%] and 623 outpatient visits [44.5%]). Patients with NP had a significantly greater mean number of pain visits per consultation (p = .008) and significantly more days of pain service follow-up (p < .001) than did other patients. The most common cause of NP was cancer treatment rather than the underlying malignancy. Pharmacologic management of NP was complex, often comprising three medications. Nonpharmacologic approaches were used for 57.6% of NP referrals. Neuropathic pain is less frequently encountered than non-NP in children with cancer; nevertheless, it is more difficult to treat, requiring longer follow-up, more clinical visits, complex pharmacologic management, and the frequent addition of nonpharmacologic interventions., (Copyright © 2014 American Society for Pain Management Nursing. All rights reserved.)

The aim of this study was to investigate the effect of relaxing music on pain intensity in patients with neuropathic pain. A quasi-experimental study, repeated measures design was used. Thirty patients, aged 18-70 years, with neuropathic pain and hospitalized in an Algology clinic were identified as a convenience sample. Participants received 60 minutes of music therapy. Classical Turkish music was played to patients using a media player (MP3) and headphones. Participants had pain scores taken immediately before the intervention and at the 30th and 60th minutes of the intervention. Data were collected over a 6-month period in 2012. The patients' mean pain intensity scores were reduced by music, and that decrease was progressive over the 30th and 60th minutes of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of music therapy in the routine care of patients with neuropathic pain could provide nurses with an effective practice for reducing patients' pain intensity., (Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

This study was designed to audit nurse assessment and documentation for neuropathic pain in postoperative patients. The audit focused on recorded signs of neuropathic pain in the immediate postoperative period. Nurses were educated on how to screen patients for neuropathic signs using the validated and reliable 7-item DN4. Data were obtained from 450 patient charts from the thoracic, orthopaedic and spinal units. Of the 450 patient charts reviewed, 423 included a record of nurse screening of neuropathic pain signs. Screening by nurses found 24% (n=102) of the patients reported between one and four signs of neuropathic pain within the first 3 days following their surgery. This study demonstrated that the incorporation of the 7-item DN4 neuropathic pain assessment tool within the generic pain chart enabled nurses to regularly screen postoperative patients for signs of neuropathic pain in the immediate postoperative period.

Fatigue is a common symptom associated with neuropathic pain (NP) and can have negative consequences on psychosocial functioning, physical endurance, and quality of life. Recent evidence indicates that immune activation modulated through the increased release of proinflammatory cytokines can predict fatigue in some patient populations. Although earlier studies have shown that immune activation is a pathophysiologic feature of NP, there have been no studies to examine the relationship between immune activation and fatigue in persons with NP. Therefore, the purpose of this exploratory study was to: 1) determine the relationships among fatigue, pain, psychosocial factors, and selected biologic markers of immune activation (interleukin [IL] 6 and soluble IL-6 receptor [sIL-6R]) in participants with persistent radiculopathy; and 2) determine the differences in these variables based on fatigue severity. Participants (n = 80) were classified according to their level of fatigue as low (27.5%), moderate (32.5%), or high (40%), and significant differences were found between fatigue categories (p = .001). Multivariate analyses of variance revealed that individuals with moderate to high levels of fatigue differed from those with the lowest levels of fatigue in psychologic distress, depressive symptoms, IL-6, and sIL-6R, whereas the differences between moderate and high levels of fatigue were significant for psychologic distress and sIL-6R only. The findings suggest that immune activation affects fatigue severity and possibly other behavioral responses, offering important information when providing care to patients with persistent radiculopathy. The integration of biobehavioral nursing interventions in pain management may have a greater impact on quality of life than treatment focused only on pain., (Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is a significant problem that has physical, functional, and psychosocial repercussions beyond the consequences of SCI. The notion that acceptance may be a viable alternative to suffering when resolution of pain is unattainable was explored. Studies indicate that acceptance of pain is associated with lower pain intensity, less pain-related anxiety and avoidance, less depression, less physical and psychosocial disability, more daily active time, and improved work status in patients who have other types of chronic pain. This exploratory qualitative study examined acceptance of pain in SCI individuals who have CNP. Grounded theory was used to develop a conceptual framework to describe acceptance in people with CNP and SCI. Data were obtained from in-depth interviews with seven SCI individuals. Six phases were identified, including: "comprehending the perplexity of CNP," "seeking pain resolution," "acknowledging pain permanence," "redefining core values," "learning to live with the pain," and "integrating pain." Two driving forces, "increasing independence" and "evolving pain view," were noted to move the process of acceptance forward. The findings in this study suggest that acceptance of pain appeared to be beneficial in terms of reducing suffering and facilitating a more satisfying and fulfilling life in these SCI individuals. A decreased emphasis on continued searching for a cure for CNP and movement toward a self-management approach was associated with increased pain coping for these SCI individuals. Clinical implications suggest that early intervention to facilitate effective coping and an exploration of the notion of acceptance could be beneficial., (Copyright © 2012 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Peripheral neuropathy (PN) is a common and often progressive condition frequently seen in primary care. The chronic pain associated with PN, or neuropathic pain, can significantly diminish patients' quality of life and be challenging to treat.

Leg ulceration represents a substantial health problem, and pain is likely to be an associated symptom. The aim of this meta-synthesis was to undertake a systematic review of qualitative studies investigating the experience of chronic painful leg ulceration. This study undertook the meta-synthesis approach described by Sandelowski and Barroso (2003), which is a synthesis and re-interpretation of the findings from several qualitative studies. Findings were extracted and synthesized. The overarching theme was that patients with chronic leg ulceration suffer from persistent pain with associated sequelae. Word descriptors used by participants also suggested that patients have neuropathic pain. In addition, findings from the meta-synthesis suggested that pain associated with chronic leg ulcer may have a neuropathic pain component. Pain associated with leg ulceration is likely to have nociceptive properties as well as neuropathic properties. If neuropathic pain is not identified and managed effectively, patients are at risk of developing a chronic pain condition with associated sequelae, such as poor sleep, depression and suicidal ideation. It is proposed that early identification and management may enable appropriate pain management which may prevent or reduce the associated risks.

Auriculotherapy is a complementary therapy recommended for the treatment of chronic pain. Effectively, the whole of the body's innervation territory is mapped out on the ear auricles, "connected" on the level of the brainstem, the relay station of all the body's sensory information. The therapy consists in inserting semi-permanent needles or localised stimulations in the auricles. The ear point is determined on the basis of neurophysiological reasoning.

Purpose/objectives: To assess the validity of neuropathy and neuropathic pain-measurement approaches., Design: Cross-sectional measurement study., Setting: Two comprehensive cancer centers in the northeastern United States., Sample: 117 patients with cancer in an outpatient setting., Methods: Participants were assessed using the five-component Total Neuropathy Score-reduced (TNSr), the TNSr short form (TNSr-SF), individual TNSr items, the Neuropathic Pain Scale for chemotherapy-induced neuropathy (NPS-CIN), and the National Cancer Institute's Common Toxicity Criteria™, version 3.0 (NCI-CTC)., Main Research Variables: Neuropathy and pain measure scores, cumulative and per M2 chemotherapy dosage, comorbid risk factors, drug class, and the number of neurotoxic drugs received., Findings: TNSr, TNSr-SF, and tendon reflex scores were greater in patients receiving higher cumulative (z range = -2.2 to -3.6; p range = 0.01 to < 0.001) and per M2 (z range = -1.8 to -2.4; p range = 0.04 to < 0.001) chemotherapy doses. Scores from most neuropathy and pain measures were higher in patients with comorbid illnesses (z range = -1.79 to -3.51; p range = 0.03 to < 0.001). Sensory NCI-CTC scores were higher in patients receiving higher cumulative chemotherapy dosage (z = -2.1; p = 0.02). Only the sensory NCI-CTC correlated with other measures (r range = 0.22-0.63; p range = 0.05 to < 0.001)., Conclusions: Findings support the validity of the TNSr, TNSr-SF, tendon reflex item, NPS-CIN, and NCI-CTC sensory grading scale when measuring taxane and platinum-induced neuropathy. However, additional validity testing is warranted., Implications for Nursing: Comprehensive neuropathy and pain measures mainly used by researchers and neurologists were simplified to more clinically useful tools for use by nurses when monitoring chemotherapy-induced peripheral neuropathy.

The purpose of this paper is to provide the reader with evidence basedclinical guidance regarding assessing neuropathic pain. Persistent pain is a huge burden on health-care provision and the prevalence of persistent neuropathic pain is likely to increase owing to the ageing population. The provision of appropriate relieving interventions depends on accurate assessment. This paper sets out to provide the reader with simple neuropathic assessment tools that can be applied to community care. This will allow the community nurse to identify patients who have neuropathic pain and will therefore enable appropriate management.

The main focus of this article, part of a series on pain, is to describe the abnormal patterns that occur in persistent and neuropathic pain states. It provides an overview of the adjuvant medications available to treat this type of pain when it does not respond to conventional methods. Treatments described require the input of pain specialists; however, the purpose of this article is to encourage nurses to assess pain accurately and to identify symptoms of neuropathic pain, thereby improving patient outcomes.

Chronic neuropathic pain affects between 20% and 50% of women after their breast cancer treatment. The Human Response to Illness (HRTI) model provides a comprehensive theoretic framework to guide the assessment and management of this pain in women with breast cancer. Knowledge of the physiologil, pathophysiologic, behavioral, and experiential perspectives, as well as personal and environmental factors, will assist nurses and other health care professionals to develop better assessment tools and improve interventions and treatment modalities. This will provide guidance for nursing practice, education, and research and ultimately improve the quality of life, optimize outcomes, and reduce the incidence of chronic neuropathic pain in the breast cancer population.

When confronted with a devastating disability or chronic illness, rehabilitation nurses play a key role in inspiring hope for patients and their families. This article examines strategies nurses can implement in everyday practice: creating an environment of hope in a rehabilitation unit; assisting patients to manage their negative feelings about their disability; relieving chronic neuropathic pain; sustaining patient relationships with staff and family; helping patients to forgive themselves and others; enhancing patient intimacy with others; using literature to promote hope; acknowledging a patient's belief that nothing is impossible; using humor therapeutically; and maintaining hope for the moment. It is the moment-the time we spend with our patients-that is essential. In that moment, we are promoting hope.

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.

Neuropathic pain and its co-morbidities can be detrimental to a patient's quality of life, affecting both physical and psychological well-being. Diagnosing neuropathic pain can be difficult and some patients may have to wait up to 12 months to see a pain specialist. The nursing contribution to recognising and managing neuropathic pain is vital if patient care is to be improved. It is therefore necessary for nurses to understand the assessment, diagnosis and management of neuropathic pain.

Chronic neuropathic pain is experienced by a large number of patients. It can affect the individual physically, psychologically and socially. This review examines the evidence base for the assessment of chronic neuropathic pain and discusses some of the main tools and their suitability for use for this particular type of pain. The central role the nurse has in pain assessment and management to improve the patient's quality of life is explored. The evidence recommends that chronic pain be assessed using a multidimensional assessment tool. Currently the only tool specifically designed to measure neuropathic pain is the Neuropathy Pain Scale. The author describes how the evidence was applied to make changes in her own area of practice and why the Brief Pain Inventory was considered more suitable than the Neuropathy Pain Scale.

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.

TRIGEMINAL NEURALGIA, which is unilateral electric shock or knifelike pain occurring in one or more branches of the trigeminal nerve, is evoked by stimulation of the face, lips, or gums caused by activities such as shaving, brushing the teeth, or moving trigger zones. IT GENERALLY IS ACCEPTED that classic trigeminal neuralgia is a consequence of vascular compression and demyelination of the trigeminal nerve. Although medical therapy is available, it gradually becomes less effective because of the progressive nature of trigeminal neuralgia. MICROVASCULAR DECOMPRESSION of the trigeminal nerve to treat trigeminal neuralgia is discussed in this article. Perioperative care, expected course of recovery, and potential complications are described.

Chronic nonmalignant neuropathic pain is difficult to manage. A challenging case dealing with chronic neuropathic pain subsequent to thoracotomy syndrome and reflex sympathetic dystrophy syndrome is presented. Strategies and approaches to aggressively manage this type of pain are presented.

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.

Effective preoperative communication and an awareness of the mechanisms and treatment of neurogenic pain by nursing staff directly influence the choice of intraoperative and postoperative pain management. This article describes the case study of a young woman with neurogenic pain and highlights the importance of having a working knowledge of this type of pain, its assessment, and treatment.

Pain management is rapidly changing as the mysteries of how healthy and damaged nervous systems work to communicate pain to the brain become better understood. The role of subcutaneous or intravenous lidocaine in the management of neuropathic pain has been increasingly studied. Patients with a variety of pain have been shown to benefit from this therapy, including patients with cancer, postherpetic neuralgia, second degree burns, strokes, and diabetes. As research and experience grow, so too will the practitioner's ability to successfully use intravenous and subcutaneous lidocaine therapy for their patients with pain.

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.