Managing the comorbidities of postherpetic neuralgia.

PURPOSE: To discuss the impact of pain and its associated comorbidities in elderly patients with postherpetic neuralgia (PHN). To review the pharmacologic treatments available for patients with chronic pain and concurrent sleep disturbance, depression, and/or anxiety.

DATA SOURCES: Relevant clinical literature pertaining to the management of common comorbid conditions in patients with PHN and chronic pain syndromes.

CONCLUSIONS

Chronic pain strongly influences physical and psychological function in elderly patients. Comorbid illnesses, such as insomnia, depression, or anxiety, often develop in patients with chronic pain and complicate overall pain management and worsen prognosis. Pharmacologic treatment strategies that reduce pain frequently result in concurrent improvements in common pain-associated comorbidities. Pharmacologic treatment should be selected based on the efficacy of the selected agent(s), potential for adverse effects, and impact on pain-associated comorbidity. A multidisciplinary pain care management approach is essential to alleviate pain, manage pain-associated comorbidities, and improve function and quality of life.

IMPLICATIONS FOR PRACTICE: Elderly patients who often deny their chronic pain are at increased risk for such conditions as sleep disturbance, depression, and/or anxiety. Nurses and nurse practitioners are in a unique position to improve pain care management by recognizing pain and its associated comorbidities early, educating patients regarding their perception of pain, and facilitating rational pharmacotherapy with the goal to improve function and quality of life.