Chronic Pain Update 2013: New Data and Perspectives - Episode 5

Educating Non-Pain Specialists on Postherpetic Neuralgia

In this video clip, the panelists explore non-pain specialists’ understanding of the effects of postherpetic neuralgia (PHN) on peripheral and central nervous systems, as well as their ability to assess treatment strategies.

According to Joseph Pergolizzi, MD, there’s a lack of medical aptitude regarding those topics that stems from “an educational deficit that we have”.

“If you look at a lot of medical school curriculum that we go through during the four years, only a very small amount of it is really dedicated to pain medicine, and yet pain is the number one reason why people seek medical care,” Pergolizzi said.

To bridge the gap in pain proficiency, Jeffrey A. Gudin, MD, notes that PHN is an effective tool for educating primary care physicians on peripheral and central nervous system sensitization because the disorder “happens at the level of the spinal cord … yet has its manifestations out on the skin”.

“I think they understand this model of ‘Something’s happening in the periphery, something’s happening in the CNS’, and that’s a great educational tool to use to say, ‘Hey, maybe we’ll use a topical analgesic preparation — like maybe a lidocaine patch or a topical anti-inflammatory —but we also need to use some neuropathic compounds and maybe even opioids for the central effect,” Gudin says. “That’s really where that peripheral-central marriage comes along.”

While moderator Peter Salgo, MD, points out that primary care doctors who are frustrated by their pain patients say “they’re always in my office; they’re always, always complaining to me about their pain,” Christopher Gharibo, MD, believes many older PHN patients are underreporting severe pain resulting from peripheral and central nerve damage.

“I think that with older patients — because of temporal summation — they actually feel pain worse and for longer than a younger patient,” Pergolizzi adds. “These patients suffer in silence, and it can have physiological changes, too. If your patient is not able to have good respiratory exchange because they can’t expand their lungs, because they don’t want to breathe, because it’s that painful, it could be problematic.”