Shingles and PHN: Medical Students Hear From Patients
Herpes Viruses Association and Shingles Support Society
The Shingles Support Society helps patients with post-herpetic neuralgia (PHN) which can follow shingles mostly in older patients. Shingles is a recurrence of chickenpox. PHN can be felt as a wide range of pain sensations from slightly irritating itching through to life-changing stabbing sensations. If PHN develops, starting treatment early increases the prospect of eliminating it. There are approximately 192,000 cases of shingles in England and Wales each year. The risk of developing PHN rises with age so that at 85 years old, 65% of patients will have PHN.
Conventional painkillers have no effect on the neurogenic pain of PHN so specialised treatment is required which many doctors are unaware of. We wish to educate medical students to recognise the severity of shingles and how to treat it.
The project will include patients who have had experience of PHN as teachers for sessions in the medical training curriculum, together with a person from the SSS who has an understanding of treatment at primary care and a healthcare provider from a Pain Clinic. We will hold 1-hour training sessions in six of the 24 medical colleges in England.
We will focus on:
- Early recognition of symptoms. There is a 72-hour window for antiviral medication to be started for best effect. Too many patients report that their early symptoms were not recognized.
- The need to warn patients at risk of PHN (the over-60s) to come back to initiate treatment before the pain has become entrenched. Too many patients report that they had left it too long for neuropathic pain medication to have an effect.
- The need to call patients back to increase the doses of neuropathic pain medication. Too many patients report that they are still on the starting dose after several months and that it is not having any useful effect.
Evaluation of each session will inform the content of the next. The aim is that the SSS can prepare a training package that can be used in all medical schools. Ideally, this would be a video.