From Consultation to Collaboration: A Patient-Centered Approach to Shingles Pain and Postherpetic Neuralgia Management.

Abstract

Background/Objectives: Herpes zoster (shingles), caused by reactivation of the varicella zoster virus, often leads to acute pain that may progress to postherpetic neuralgia (PHN). Current evidence is insufficient to determine the optimal interventional treatment for these conditions. This study aimed to evaluate the effectiveness of shared decision-making (SDM) forms developed by MacKay Memorial Hospital (MMH) in reducing patient anxiety and improving personalized care. Method: Between 1 August 2022 and 30 August 2024, we retrospectively reviewed SDM records of patients with shingles pain and PHN who were referred to the pain clinic for interventional treatment due to unresolved pain. The SDM forms were developed, reviewed, and authorized by the MMH Committee of Medical Quality and Safety. We analyzed the chosen interventions, anxiety levels, pain intensity, and patient preferences regarding treatment selection. Results: A total of 51 individuals (36 with shingles pain, 15 with PHN) were included in this cohort study. Most patients with acute or chronic zoster pain opted for subcutaneous steroid injections. Anxiety scores significantly decreased following SDM intervention, from 5.0 (IQR: 3.5-5.0) to 3.0 (IQR: 2.0-3.0) in shingles patients and from 5.0 (IQR: 4.0-5.0) to 2.0 (IQR: 2.0-3.0) in PHN patients. Pain intensity, measured using the numerical rating scale (NRS), also improved markedly after interventional pain management, with scores reducing from 8.0 (IQR: 6.0-9.0) to 3.0 (IQR: 1.0-6.5) in shingles patients and from 5.0 (IQR: 4.0-8.0) to 2.0 (IQR: 1.0-3.0) in PHN patients. Shingles patients expressed greater concern about the risks of interventional therapy complications, whereas PHN patients prioritized cost, complication rates, treatment frequency, and continuity of care. Additionally, SDM forms received high scores for promoting patient participation and knowledge, indicating that they improved their understanding of their condition and treatment options. Conclusions: SDM significantly improved patient comprehension, reduced anxiety, facilitated informed treatment decisions, and strengthened doctor-patient communication for those with shingles pain and PHN.