Arizona Pain Monthly - October by Arizona Pain Specialists

October 2011

GARDENING GOODNESS Finding health in your backyard PAGE 10

NO PAIN, NO GAIN

Acupuncture a respected form of pain management PAGE 5

PLUS October Cooking ➲ p.7

What is Post Herpetic Neuralgia? ➲ p.13

October 2011

WELCOME T h i s month’s theme for our m a g a zine is “gro wth.” Humbly, w e k now a bit about the topic. C a n you believe just three y e a r s ago, we started Arizona Pa i n Specialists with two phy s i c i a ns and fewer than five e m p l oyees? Today, thanks to t h e many blessings we’ve re c e i ved and plenty of hard w o r k , we have three locations, s e v e n physicians and more t h a n 150 staff members. A r i z o n a Pa i n S p e c i a l i s t s k n o w g r o w t h . M o s t i m p o r t a n t l y, t h i s i n c r e a s e i n s t a ff a n d size means we can treat the growing number of patients in chronic and acute pain w h o n e e d o u r h e l p . We a r e thankful to be in this field for many reasons – including its growth in the last 10 years. There are new proced u r e s , t e c h n o l o g i e s a n d p h a rmaceuticals we are able to try because of the increase in research and interest in pain management. T h i s monthly magazine is one f r u i t reaped from our growing s u c c ess, as is our website: w w w. arizonapain .com We are h a p p y to be able to provide

Paul Lynch, MD and Tor y McJunkin, MD

We continually ask God to fill you with the knowledge of his will through all the wisdom and understanding that the Spirit gives, so you may live a life worthy of the Lord and please him in every way: bearing fruit in every good work, growing in the knowledge of God, being strengthened with all power according to his glorious might so that you may have great endurance and patience, and giving joyful thanks to the Father, who has qualified you to share in the inheritance of his holy people in the kingdom of light.

Colossians 1: 9-13

our pat i e n t s a n d c o m m u n i t y with re g u l a r l y u p d a t e d h e a l t h informa t i o n a b o u t p a i n c o n d itions a n d t re a t m e n t s .

the healing powers of growing a garden, including an interview from a local permaculture expert.

In this month’s issue, we are happy to include information from our growing chiropractic team about spinal manipulations. Two of our chiropractors explain what to expect when visiting them on the table. We also have a feature article on

With this, we hope your O c t o b e r b r i n g s g ro w t h t o y o u – a n i n c re a s e o f p e a c e , h a p p iness and health. From our families to yours, Paul Lynch, MD and Tory McJunkin, MD

October 2011

Clinical Editor: Tory McJunkin, M.D. Publisher: Nick Ryan Editor/Writer: Kelli Donley,

CONTENTS 3

Layout: Addie Mirabella

Welcome letter

By Chance Moore, DC and Nicole Kibler, DC

Dr. Paul Lynch and Dr. Tory McJunkin welcome you to the October issue of Arizona Pain Monthly.

Jennifer Gitt

Boost Medical

9977 N 90th Street, Suite 320 Scottsdale, AZ 85258 Phone: 888-627-6121

Email: info@boostmedical.com

No Pain, No Gain

Print Subscription Information

Acupuncture a respected form of pain management

888-627-6121

October Cooking October brings the first crisp, cool nights to Phoenix â&#x20AC;&#x201C; a taste of the next glorious six months.

Published monthly by Boost Medical 9977 N 90th Street, Suite 320 Scottsdale, AZ 85258 Volume #19 Published October, 2011

Spinal Manipulation

Gardening Goodness Finding health in your backyard By Kelli M. Donley, MPH

Pain Q&A What Is Post Herpetic Neuralgia?

October 2011

N o Pain, N o G ain A c u p u n c t ure a Respected For m o f Pa i n M anagement Linda Gibbons, a licensed acupuncturist and board member for the Acupuncture Association of Colorado, says having needles inserted in the skin to relieve pain doesn’t make sense to most A m e r i c a n s a t f i r s t . H o w e v e r, Gibbons, who is also on faculty at the Colorado School of Chinese Medicine, says this form of eastern medicine is quickly becoming a more accepted and respected form of pain and stress relief. Q : H ow can acupuncture p ro v i de pain relief? A: Research shows acupuncture stimulates the brain to release endorphins, which a r e p a i n - r e l i e v i n g h o r m o n e s . Acupuncture also stimulates the brain to release

blood constriction near the needled area, which promote healing, and the flow of fresh blood and nutrients to the area. From a Chinese medicine perspective, acupuncture balances the Qi (energy) of the body by releasing constraint, promoti n g e n e r g y f l o w, a n d b a l a n c i n g t h e o r g a n s y s t e m s . Q: How d i d y o u g e t i n t e re s t e d in acup u n c t u re ? A: I had h e a l t h i s s u e s a n d found t h a t a c u p u n c t u re a n d Chinese m e d i c i n e w e re w h a t helped m e h e a l . Q: Who i s y o u r t y p i c a l c l i e n t ? What ty p e o f p a i n re l i e f a re they se e k i n g ? A: I am a generalist, in that

I treat everything from acute illnesses, such as cold and flu, to chronic pain and internal conditions, such as: digestive, neurological, or hormonal imbalances. I use herbal medicine with most of my patients. About 60% of my patients I treat for pain, and the rest for internal conditions. I treat those age 10 to 90 years old. Q : I s a c u p u n c t u re s a f e ? A : A c u p u n c t u re i s v e r y s a f e . Acupuncturists have 3-4 years of training and most states re q u i re l i c e n s i n g . T h e m o s t c o m m o n a d v e r s e s i d e e ff e c t f ro m a c u p u n c t u re i s b r u i s i n g . Q: What should you look for when trying to find a good a c u p u n c t u r i s t ? A : M o s t s t a t e s re g u l a t e a c up u n c t u re , s o l o o k f o r a l i c e n s e d a c u p u n c t u r i s t . I w o u l d re c o m m e n d y o u a s k an acupuncturist about their training and if they went to an a c c re d i t e d a c u p u n c t u re s c h o o l and if so how many hours of training they had. Q: What should you expect d u r i n g a n a c u p u n c t u r i s t v i s i t ?

October 2011

Research shows acupuncture stimulates the brain to release endor phins, which are pain-relieving hor mones.

A : T h e f i r s t t i m e I d o a t h o rough health intake, followed by a treatment. Depending o n t h e p r a c t i t i o n e r, n e e d l e s are retained anywhere from fifteen to 45 minutes.

Q: Wha t i s t h e t y p i c a l e x p e n s e ? A : L i k e m a s s a g e , c h i r o p r a c t i c o r p h y s i c a l t h e r a p y, a c u p u n c A: Trea t m e n t c o s t s a l s o v a r y b y t u r e i s a t h e r a p y. I n i t i a l l y practiti o n e r. A t t h e l o w e n d , you may be treated 1-3 times costs m a y r a n g e f ro m $ 2 0 - $ 4 5 per week depending on your for ear o r g ro u p ( c o m m u n i t y ) complaint and pain level. As acupun c t u re . Ty p i c a l l y a t re a t- p r o g r e s s i s m a d e t r e a t m e n t s Q: How can you prepare for a ment c o s t s b e t w e e n $ 6 0 - $ 8 0 c a n b e s p r e a d o u t . I n i t i a l l y, visit? What should you wear, etc? for an h o u r, p l u s h e r b s i f p rea course of 6-10 treatments is scribed . M o re i n s u r a n c e p l a n s common. A: You should dress comfortably are cov e r i n g a c u p u n c t u re and wear loose clothing. You now, so c h e c k y o u r p l a n f o r Q : H o w c a n o u r re a d e r s g e t i n should be well hydrated and coverag e . touch with you? have eaten enough prior to the visit so your blood sugar level Q: How o f t e n w o u l d y o u e x p e c t A : L i n d a G i b b o n s , L . A c . , is stable. to be t re a t e d ? phone 720-530-8218 www.sagemountainwellness.c o m

October 2011

O ctober CO O K I NG

M a y t h e re s p i t e o f c o o l w e a t h e r re a c h u s this month! October brings the first crisp, cool nights to Phoenix – a taste of the next glorious six months. In celebration of the a b i l i t y t o re t u r n o u t s i d e f o r m e a l s o n t h e p a t i o , a c o l l e c t i o n o f f a l l - i n s p i re d re c i p e s :

Tangy Grilled Acorn Squash Ingredients: • 2 pounds acorn squash • 2 tablespoons olive oil • 1 clove garlic minced • salt • 2 tablespoons red wine vinegar • 2 tablespoons brown sugar chopped fresh mint Directions:

Heat grill. Prepare squash by halving and removing seeds. Peel the pumpkin and cut into 1/2 inch sections. In a bowl, combine oil, garlic and salt to taste. Coat pumpkin in this mixture and then carefully place on the grill. In a saucepan, combine vinegar and sugar. Cook until the syrup is thick. Drizzle over squash and garnish with mint.

Stuffed Squash Ingredients: • 6 ounces wild rice • 2 cups vegetable or chicken broth • 1 teaspoonthyme • 1 cup celery, chopped • 1 medium onion, chopped

• 1 tablespoon olive oil • 3/4 cup dried cranberries • 1/2 cup toasted, chopped almonds • 2 tablespoons minced fresh parsley • 4 medium acorn squash • 3/4 cup water Directions: Heat oven to 350 degrees. In a saucepan, bring rice, broth and thyme to a boil. Reduce heat; cover and simmer for 25 minutes. In a frying pan, brown celery and onion in oil. Remove fro heat, and add cranberries, almonds, parsley and finally the cooked rice. To prepare squash, halve and remove seeds. Fill squash with rice mixture and place on a greased baking sheet. Bake for 45-50 minutes, until squash is tender.

Peanut Butter Pumpkin Cookies Ingredients: • 2 cups sifted flour • 1 1/4 teaspoons baking powder • 1 teaspoon baking soda • 1 teaspoon cinnamon • 1 teaspoon nutmeg • 1/4 teaspoons ground ginger • 1/8 teaspoon ground cloves • 1/2 teaspoon salt • 2 large eggs • 1 1/4 cups light brown sugar • 1/2 cup oil • 1 teaspoon vanilla extract • 1 cup chunky peanut butter • 1 cup canned pumpkin puree Directions: Heat oven to 325 degrees. Combine dry ingredients – flour, baking powder, baking soda and spices. Set aside. In another bowl, combine eggs and sugar – whisking together until smooth. Add all other wet ingredients: vanilla, pumpkin, peanut butter and oil. Slowly add dry ingredients to wet, mixing thoroughly. Using an ice cream scoop for consistency, dollop batter on greased baking sheets. Bake for 15 minutes. Cool on baking racks.

October 2011

Spinal Manipulation B y Chance Moore, DC and Nicole K i b l e r , D C Spinal Manipulation techniques have been used to treat back pain worldwide since early recorded history. Artwork and artifacts from different cultures â&#x20AC;&#x201C; including Egypt, Native America, Thailand, China, and Japan â&#x20AC;&#x201C; depict various forms of spinal manipulation. Hippocrates describes different forms of spinal manipulation using tables similar to modern chiropractic tables. Spinal manipulation was modernized by the founders of chiropractic and osteopathy. Today, spinal manipulation is most closely associated with Doctors of Chiropractic, (DC). There are Doctors of Osteopathy, (DO) who practice spinal manipulation as well. The spine is made of many small bones called vertebrae. Each vertebra is aligned in a column and connected by small joints. These small joints of the spine can become stuck or restricted, resulting in pain and stiffness. This can be caused

by a single traumatic event, such as improper lifting of a heavy object, or through repetitive stresses -- like sitting in an awkward position with poor spinal posture for an extended period of time. In either case, injured tissues undergo physical and chemical changes that can cause inflammation, pain, and diminished function. The purpose of spinal manipulation is to restore joint mobility by applying a controlled force to joints that have become restricted in their movement as a result of tissue injury. In many cases, such as lower back or neck pain, spinal manipulation therapy may be the primary method of treatment. When other medical conditions exist, spinal manipulation may compliment or support medial treatment by relieving the musculoskeletal aspects associated with the condition. T h e re a r e m a n y d i ff e r e n t t y p e s

Chance Moore D.C. D octor of Chiropractic

of spinal manipulation with more than 100 named techniques. Some forms are gentle and subtle, while others utilize more speed and force. It is important to realize the determination of technique of manipulation is medical decision made between the patient and the doctor performing the manipulation. While some forms of manipulation are not appropriate for patients at risk for fracture or stroke, there are many manipulation techniques that are. Manipulation is widely recognized as one of the safest non-invasive therapies available for the treatment of neuromusculoskeletal complaints. Still patients fear the associated cracking or popping sound because they do not know

October 2011

Other spinal manipulation techniques include:

what it is. The pop sound occurs when a joint has been moved past the elastic barrier of restriction, but still within the normal range of motion. When this happens, a release of nitrous oxide gas causes the popping sound. This sound is normal and does not indicate damage or injury. There are a wide variety of low force techniques that do not reproduce any noises, the most utilized forms of low force manipulation are flexion distraction and activator. The flexion-distraction technique is a gentle spinal manipulation procedure performed on a special table that helps to separate the thoracic, cervical and lumbar spinal joints. Light pressure is applied to the spine with the intent to decompress the inflamed areas around the spine to restore normal joint movement. The flexion-distraction manipulation technique is based on a distractive force, supplied with the chiropractor’s hand, combined with table motion. The table is designed to restore normal physiological range of motion to the cervical, thoracic and lumbar spinal joints. Additional goals of the flexion-distraction adjustment include increased nutrients into the spinal disc, decreasing

• • • • • • • • • • • •

Activator Methods Applied Kinesiology Atlas Orthogonality Atlas Specific Bi o E n e r g e t i c S y n c h ro n i z a t i o n Te c h n i q u e (B . E . S . T. ) Chiropractic Biophysics (CBP) Clinical Kinesiology Flexion-Distraction Craniopathy/Cranial Therapy D i re c t i o n a l N o n - Fo rc e Te c h n i q u e ( D . N . F. T. ) G o n s t e a d Te c h n i q u e

intradiscal pressures and decompressing inflamed/compressed spinal nerve roots. Activator is a hand-held tool that is designed to give patients a gentle adjustment. The activator tool provides a controlled, fast thrust that is comfortable for the patient. Activator technique is a gentle, low-force approach to chiropractic care. The technique has been used safely on patients of all ages since the 1960s. The technique is especially helpful for children who sometimes have trouble staying still, and is safe for older patients with osteoporosis at risk for fracture. The technique utilizes specific protocols to detect spinal joint dysfunction based on functional leg length inequality. The activator technique is the most widely used

• H o l e - I n - O n e ( H .I .O. ) • L i f e U p p e r C e r vi c a l A d j u s t i n g Te c h n i q u e • L o g a n B a s i c Te c h n i q u e • M i c ro - M a n i p u l at i o n • M o t i o n Pa l p a t i o n • Pa l m e r F u l l S p i n e Diversified • Pa r k e r S y s t e m • Pe t t i b o n Te c h n i q u e • Sacro-Occipital Technique (SOT) • T h o m p s o n Te c h n i q u e ( d ro p - p i e c e t a b l e ) • To f t n e s s Te c h n i q u e low-force chiropractic technique in the world. Spinal manipulation can be a good compliment to other pain management treatments including epidural injections, medial branch blocks, and medication management. It can also be effective in combination with physical therapy to strengthen and stabilize your spine. A multi-disciplinary approach to treating pain is best. Patients should be encouraged to continue all of your other types of treatments while receiving spinal manipulation therapy. These may include: injections, physical therapy, acupuncture, behavioral assessments and medications. A combined approach of multiple modalities is the most effective way to treat these complicated chronic pain problems.

October 2011

Gardening Goodness F i nd i n g Health in Your Backyard B y Kelli M. Donley, MPH I t ’s n o secret that Arizona has o n e of the harshest climates in t h e c ountry. Record heats make e v e n the saguaro sag at times. T h e dry desert floor is thick w i t h caliche clay – making t i l l i n g and drainage difficult. A n d yet, Phoenic ian garden e r s k now another secret: this s a m e earth can be nurtured to p ro d uce year-rou nd gardens t h a t provide the healthiest b o u n ty – a steady supply of o r g a nic fruit and vegetables. C o u n tless research has shown a re g ular diet of fruit and veg e t a b l es is ideal; however, a re c e nt study from the Colorado S c h o ol of Public Health shows g a r d eners also report a cornu c o p i a of health benefits from b e i n g outside, connected to t h e e arth. The research showed g a r d eners had more extensive c o m munity engagement, stron g e r s ocial relationships, and

were m o re s u p p o r t i v e o f p o sitive he a l t h - re l a t e d b e h a v i o r s and ove r a l l h e a l t h t h a n t h e i r non-ga r d e n i n g c o u n t e r p a r t s . Getting y o u r h a n d s d i r t y in the g a r d e n m a y n o t j u s t feed yo u r s t o m a c h , b u t m a y also be g o o d f o r y o u r h e a r t . Liz Lon e t t i , m a s t e r g a r d e n e r and exe c u t i v e d i re c t o r o f t h e Valley Pe r m a c u l t u re A l l i a n c e in Phoe n i x s a y s a c o n n e c t i o n to gard e n i n g , f o o d a n d h e a l t h should b e c o m m o n s e n s e . “Our bo d i e s a re l i t e r a l l y m a d e out of t h e f o o d w e p u t i n o u r mouths , ” s h e s a y s . “ T h e m o re vibrant , h e a l t h y a n d c l e a n m y food is , t h e m o re m y b o d y a n d mind re f l e c t s t h o s e q u a l i t i e s . This fac t b e c a m e e v e n c l e a re r during m y p re g n a n c y l a s t y e a r. The tho u g h t o f m y b a b y b e i n g made o u t o f t h e f o o d I a t e d e finitely m a d e m e l o o k t w i c e

a t a n y t h i n g t h a t c a m e p re bagged, canned or boxed! What I d o n ’t g ro w m y s e l f , I u s u a l l y p u rc h a s e o r g a n i c a n d t h o s e a re all new habits.” As the leader of the Valley Permaculture Alliance – a nonprofit focused on

October 2011

healthy food and outdoor exercise, the benefit I find the best was probably the least anticipated – that of exercising my mind. I love researching, tinkering and experimenting with which plants will grow and do best in which microclimates in my yard.” L o n e t t i s a y s s h e ’s s e e n t h e h e a l t h b e n e f i t s o f ga r d e n i n g a m o n g f r i e n d s a n d f e l l o w V PA members too. “My neighbor’s sister lost her husband of 50 years and found great relief in a friend’s meditation garden walking a labyrinth path,” she says. “She claimed it saved her life and I don’t doubt it. Geoff Lawton, one of the world’s top permaculture designers, famously said, ‘All the world’s problems can be solved in a Garden.’ I believe that includes much of the suffering we experience in life.”

G etting your hands dirty in the garden may not just feed your stomach, but may also be good for your heart.

encouraging Phoenicians to garden and live more sustainable lives – Lonetti has become a well-known garden guru.

“I don’t think of gardening and sustainable living as influencing my life, rather it is my life, it’s who I am,” she says. “Besides the obvious benefits of fresh

Fo r t h o s e w h o d o n ’t h a v e the space, time or energy to g a r d e n – L o n e t t i s a y s c o nnecting with local farmers is another way to support sustainable living, and eat s e a s o n a l l y. “ D o n ’t w o r r y a b o u t g a r d e ni n g i f y o u a re i n c i rc u m s t a n c e s

October 2011

t h a t inhibit playing in the s o i l – do what you can,” she s a y s . “Join a CSA (Community S u p p orted Agricu lture, www. l o c a l harvest.org/csa) and s u p p ort your local farmers w h i l e enjoying the fresh e s t s easonal produce avail a b l e . Beyond tha t, start with w h a t inspires you and start s m a l l. You can’t go wrong w i t h composting, even if you d o n ’t have a garden to put t h e c ompost on, plants any w h e re would be happy to take s o m e. Additionally, you could p l a n t a few herbs in a pot and s e e what happen s. Above all, re m a in curious, experiment a n d keep an open mind.” S u s t ainable has been a buzz w o r d for several years. Lonetti s a y s so much can be mark e t e d as “green” or “sustain a b l e , ” but the average person m a y not know how to apply t h e s e concepts in their own h o m e. Doing so, she says, c re a t es a significantly health i e r e nvironment. “Sustainable living begins with assessing the flow of energy and resources in your life,” she says. “For me, it was a matter of really analyzing where the consumables I purchase come from, how I will use them, and what

Countless research has shown a regular diet of fr uit and vegetables is ideal.

happens when I’m done with the product. This made me realize how out of balance my ideals were from my daily practice. I started looking to my friends and neighbors for ‘stuff’ that I would ordinarily have just gone out and purchased. For instance, my neighbor and I pooled our resources and purchased a pressure canner to have canning parties to put up the produce we grow. I find I’m willing to spend more of my money and time on the food that I feed my family and friends and much less on everything else.” For tho s e i n t e re s t e d i n g e t t i n g their ha n d s d i r t y w i t h a garden , b u t d o n ’t k n o w w h e re to star t , L o n e t t i s a y s t h e V PA has ma n y re s o u rc e s . “It’s a g o o d w a y t o c o n n e c t with a g ro u p o f l i k e m i n d e d

people making those small c h a n g e s t o w a r d s s u s t a i n a b i li t y, ” s h e s a y s . “ T h e re i s a wealth of information on our website about many topics, including gardening in the desert, composting, keeping u r b a n c h i c k e n s a n d m o re . ” Sitting outside in the garden to meditate, feeling your heartbeat rise and the sweat bead on your brow after an exhilarating weeding session, or harvesting a crop of juicy, homegrown tomatoes can bring peace of mind and pain relief. Gardening also provides a healthy reminder of seasonal eating. With fall temperatures, there has never been a better time to get outside and get involved. Fo r a d d i t i o n a l i n f o r m a t i o n , o r t o c o n t a c t L o n e t t i – v i s i t : w w w. v a l l e y p e r m a c u l t u re a l l i a n c e . o r g .

October 2011

Pain Q&A W h a t I s Post Her petic Neuralgia? Pe r h aps the most disturbing w o r r y for those who have a s h i n gles outbreak is the threat o f p ost herpetic neuralgia. T h i s side effect of shingles is a p a i nful nerve and skin con d i t i o n caused by the virus h e r p es zoster. The same virus i s re sponsible for chickenpox i n y o uth inexplicably causes s h i n gles in some adults. In t u r n , post herpetic neuralgia is t h e persistent, often qualityo f - l i f e-altering pain associated w i t h a shingles outbreak.

the risk of post-herpetic neuralgia by 67%. The vaccine was most effective in people age 60-69, but also provided some protection for older groups. Research continues on how long the vaccine lasts; current data show the vaccine protects adults from the illness, and the painful side effects, for at least six years. Those age 60 and older should request a Zostavax vaccine from their pain physician or general practitioner as a smart method of prevention.

Yet – there is good news. Shingles and related post herpetic neuralgia are entirely preventable via vaccine. Since 2006, a shingles vaccine has kept many older adults free from such outbreaks. Health officials at the Centers for Disease Control and Prevention (CDC), report a clinical trial involving thousands of adults 60 years old or older, showed Zostavax – the shingles vaccine – reduced the risk of shingles by about half (51%) and

For tho s e w i t h o u t t h e v a c c i n e , post he r p e t i c n e u r a l g i a m a y develop a f t e r a s h i n g l e s o u tbreak. T h e m o s t c o m m o n sympto m i s a b u r n i n g p a i n that ke e p s t h e p a t i e n t f ro m sleep a n d d i m i n i s h e s a p p e t i t e . Shingle s p a t i e n t s w h o a re a b l e to see a p a i n p h y s i c i a n w i t h i n the firs t 7 2 h o u r s o f t h e s i gnature r a s h a p p e a r i n g a n d c a n start a c o u r s e o f a n t i v i r a l s a re half as l i k e l y t o d e v e l o p p o s t herpeti c n e u r a l g i a . T h e c o n d ition is c a u s e d w h e n n e r v e s a re

d a m a g e d d u r i n g a s h i n g l e s o u tb re a k . T h e n e r v e s be c o m e c o nf u s e d a n d n o l o n g e r c o m m un i c a t e d p ro p e r l y b e t w e e n t h e s k i n a n d t h e b r a i n . T h e re s u l t is sharp, annoying pain that m a y b e s o s e v e re , th e l i g h t e s t t o u c h c a n c a u s e a g o n y. Po s t h e r p e t i c n e u r a l g i a p a i n i s t y p ically located at the same site o n t h e b o d y w h e re t h e s h i ng l e s o u t b re a k i n i t i a l l y o c c u r re d – usually one side of the b a c k , c h e s t o r s t o ma c h . O t h e r common symptoms include: • Burning, sharp and jabbing pain • Itching or numbness • Muscle weakness or paralysis • Sensitivity to any touch D u r i n g a v i s i t w i t h a p a i n p h ys i c i a n , a p o s t h e r p e t i c n e ur a l g i a p a t i e n t s h o u l d b e p rep a re d t o a n s w e r a s e r i e s o f questions about the shingles o u t b re a k , t h e s y m p t o m s s u ff e re d , t h e f o r m s o f p a i n re l i e f a l re a d y e x h a u s t e d , e t c . T h e re i s n o s p e c i f i c t e s t f o r p o s t h e rp e t i c n e u r a l g i a , n o r i s t h e re a s p e c i f i c c u re . H o w e v e r, a variety of pain medications a n d o p t i o n s m a y b e p re s c r i b e d u n t i l t h e p a t i e n t a nd p h y s i c i a n find the right combination. T h e s e m a y i n c l u d e : a n t i d e p re ssants, anticonvulsants, pain re l i e v i n g s k i n p a t c h e s , o p i o i d s , t o p i c a l p a i n c re a m s .

October 2011

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