Instructions
You are a medical student on placement in general practice. Your next patient is Elsie Tamwoy, 74, a Torres Strait Islander woman with pain on the left side of her chest for four months. The GP has diagnosed postherpetic neuralgia and asked you to explain it and the plan.
Explain the diagnosis and your management plan to the patient
- You do not need to take a history or examine the patient.
- The examiner will ask you one question at the end.
GP's history today
Shingles rash, left mid-back to below the breast; valaciclovir from day 6; healed in 4 weeks. Since then constant burning in that band, electric jabs several times a day and pain from light touch (cannot bear her bra). About 7/10, worse at night; poor sleep. No new rash; eyes spared.
Background and medicines
High blood pressure. eGFR 50 mL/min/1.73 m2, stable. Two falls last year, no fractures; stick outdoors. Perindopril 5 mg daily. Paracetamol 500 mg with codeine 30 mg, 2 tablets 3 or 4 times a day for 3 months: little help, constipated. No allergies. No shingles vaccine. Lives with her daughter.
GP's examination today
Healed, patchy pale and darker skin in a band from the left mid-back to below the breast; no blisters. Light stroking there is very painful; pinprick reduced in the same band. Rest of the neurological examination normal.