Communication gaps between physicians and patients with postherpetic neuralgia: results from a national study on practice patterns

Abstract

BackgroundThe purpose of this study was to identify differences in perceptions of care regarding postherpetic neuralgia, including communication patterns between patients and physicians and levels of satisfaction with therapies and care.MethodsA survey was developed for physicians (neurologists, internists, and family physicians) and patients with postherpetic neuralgia in order to determine their perspectives on its management.ResultsA total of 142 eligible patient respondents were included in the study, and responses were compared with those of 150 primary care physicians and 76 neurologist respondents. Few patients and physicians indicated satisfaction with the currently available treatments for postherpetic neuralgia. While nearly all physicians responded that they discuss the cause of postherpetic neuralgia with a patient, one in four patients indicated that their physician did not discuss the cause. Similarly, one in four patients were not aware of the duration of postherpetic neuralgia, the treatment side effects, or what to expect from treatment. Patients may be less likely to discuss treatment side effects and quality of life issues than physicians perceive.ConclusionPhysicians and patients have similar perceptions regarding treatment options for postherpetic neuralgia; however, certain gaps in communication were evident, which may be attributable to physician knowledge and communication skills with patients. Strategies to improve issues of expected outcomes and side effects of treatment may be useful to physicians.

Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider

“…Pain and its interference with daily activities are subjective symptoms and difficult to manage effectively, even more so in older patients, who are predominantly afflicted with PHN, and who are more likely to have multiple chronic health issues and declining function and frailty 29,30. A significant number of patients who develop chronic pain associated with PHN do not receive evidence-based, recommended treatment modalities, leaving many patients undertreated and dissatisfied with the treatment 24,31,32. To ensure optimal results, the initial choice of PHN pain therapy should be guided not only by drug efficacy but also by the patient’s comorbidities, severity of PHN pain, the drugs’ adverse-event and drug-interaction profiles, titration regimen, and patient preference, especially since no single therapy has demonstrated superior effectiveness.…”

“… 29 , 30 A significant number of patients who develop chronic pain associated with PHN do not receive evidence-based, recommended treatment modalities, leaving many patients undertreated and dissatisfied with the treatment. 24 , 31 , 32 To ensure optimal results, the initial choice of PHN pain therapy should be guided not only by drug efficacy but also by the patient’s comorbidities, severity of PHN pain, the drugs’ adverse-event and drug-interaction profiles, titration regimen, and patient preference, especially since no single therapy has demonstrated superior effectiveness. Because PHN is a complex condition and should not be simplified to a localized area of pain, the most practical therapeutic approach may involve a systemic medication or combination therapy rather than topical analgesics alone.…”

Low Trend for VZV-Associated Disease Patients to Visit Neurologists

“…This leaves the choice of agents and timing of evaluation to the physician's discretion. [7][8][9] A survey of internists and family practitioners found the median number of yearly patient visits for HZ and PHN was two and four, respectively. 10 Unfortunately, only one-quarter of physician respondents referred patients with HZ, and two-thirds referred patients with PHN to a subspecialist.…”