[Verified Answer]: VI

VI. Pain Management: Acute and Chronic Pain History A 64-year-old female presents with a 2 day history of intense pain along her left posterior chest wall. She comes in today complaining of a burning rash in this area. Calamine lotion and Tylenol have been ineffective. She is grieving over the recent death of her spouse of 40 years. Assessment Examination reveals allodynia along the left T5–T7 dermatome, with a blistering rash in the middle aspect of the dermatome. She is exhausted and unable to sleep or eat due to intense pain. An otherwise healthy older adult woman with a remote history of chickenpox presents with a classic case of herpes zoster. It is imperative to start antiviral therapy immediately. Judicious amounts of a short-acting opiate may also provide adequate pain relief in the acute phase. She is prescribed Valtrex 1 g three times a day, along with Vicodin 5/500, starting with half a tablet every 3 to 4 hours. She is to return to the office in 2 days. Follow-Up Visit She returns 2 days later, stating that the pain continues to be severe, but the blistery rash has not worsened. She takes one Vicodin every 4 hours, is able to sleep for short periods, and eats little. Examination reveals severe allodynia along the left T5–T7 dermatome. The blisters are drying and no new blisters have formed. When she returns 1 week later, the blisters have resolved, but she continues to have significant allodynia. She cannot wear her undergarments. She has cut down the Vicodin to half a tablet three times a day because of constipation and sedation. 1. What would be a nonopioid plan of care for a patient with postherpetic neuralgia? 2. What education does the patient need regarding taking gabapentin or pregabalin?