Page 427 – Clinical Pain Advisor

Herpes Zoster (shingles, zoster, zona)

Are You Confident of the Diagnosis? What you should be alert for in the history A history of prodrome with acute stinging, itching, burning, paresthesias, and hyperesthesia in a single dermatome is characteristic of herpes zoster. Patients may also complain of constitutional symptoms (headache, malaise, fever). Typically, pain begins and a unilateral rash of erythematous…

Shoulder Impingement

The Problem Shoulder impingement is a common cause of shoulder pain, described by Neer in 1972 as a ridge of proliferative spurs on the undersurface of the anterior process of the acromion. These spurs allow for repeated contact of the rotator cuff and humeral head with traction of the coracoacromial (CA) ligament. The concept of…

Optic neuritis

OVERVIEW: What every practitioner needs to know Are you sure your patient has optic neuritis? What are the typical findings for this disease? Optic neuritis is an acute inflammation of the optic nerve often due to demyelination or direct infection of a nerve with an accompanying inflammatory immune response. The primary symptoms a patient will…

Post-herpetic neuralgia

Post-herpetic neuralgia (PHN) refers to the development of pain in a dermatomal distribution after a varicella zoster infection. Zoster infection reflects latent virus harbored in nerve cells, which reactivates due to a decrease in immunity, most commonly as patients age. Varicella zoster frequently causes pain, but only a subset of patients develop post herpetic neuralgia,…