Shingles pain

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I had a pt in LTC who suddenly complained of unbearable abdominal and back pain. I palpated her abdomen, it was firm and painful in the RUQ and visibly knotted. I didn't have any prescribed meds to work for this and chart had no indication of GI history. I called the doctor, as soon as he found out she had shingles he ordered ativan, which seemed to work after awhile, though she remained tender.

So I suppose I don't know enough about shingles because I was thinking rash, can cause blindness ect...any info would be much appreciated.

Specializes in Rehab, Infection, LTC.

i recently got called on the carpet by the DON and the NP for getting a patient increased pain meds from the doc on call for the pain associated with her shingles. both said that "shingles doesnt hurt THAT bad". seriously, they said that.

all i had done was gotten the order to increase the hydrocodone to 7.5mg/325 from 5/325.

sometimes it is just easier to beat your head against a brick wall.

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Specializes in pediatrics, palliative, pain management.

Not sure from initial post if this is shingle pain (post herpetic neuralgia), or something else. But just a thought about the ativan. Ativan is fabulous for anxiety, but really shouldn't be used for pain tx, especially in populations who may not be able to report/ describe their pain really well (elderly, cognitively impaired, young children etc.). The problem is that ativan can get rid of the agitated behaviour and cause the pt to sleep but not help with the pain. So the pt appears comfortable but may be still in pain.

Also, shingle pain is typically neuropathic in nature. So this should be dealt with differently (antineuroleptics, antidepressants, capsican cream).

I would want to do a really thorough pain assessment on this patient .... OPQRST works great!

O= onset

P = provoke/ palliate

Q = quality (throbbing, stabbing, tingling, burning etc)

R = region / radiating

S = severity (0-10 etc)

T = timing (constant, intermittent, worse at night?)

Hope this helps :wink2:

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Specializes in Family planning, med-surg.

I thought maybe it was a bowel obstruction. The charge nurse felt the shingle pain was due to muscle spasms and the ativan was being used as a muscle relaxer. She was prescribed oxycontin ER to handle it daily.

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Specializes in ortho, hospice volunteer, psych,.

nothing really helpful to contibute but just wanted to share my husband's experience. he woke up one saturday morning in agonizing pain. he showed my his waistline and around his neck. he had sore places all around both places. he had had chicken pox when he was six and an appy when he was twelve. i said, "i don't know. maybe it's shingles and if it is, you need to get the vaccine soon. to the er we went. they said it was not shingles, but some kind of rash. the gave him a cortisone shot.

by monday morning, he couldn't stand the pressure of clothes or the heat of a blanket or the shower.

it took until wednesday to be correctly diagnosed... just what i'd thought in the first place ... shingles.

he was given pain killers and told to use cold compresses. he continued to teach but by the end of the week, two students had announced they were pregnant. it all resolved, but point being, not all shingles resemble "typical" shingles.

sharpeimom:paw::paw:

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i recently got called on the carpet by the DON and the NP for getting a patient increased pain meds from the doc on call for the pain associated with her shingles. both said that "shingles doesnt hurt THAT bad". seriously, they said that.

all i had done was gotten the order to increase the hydrocodone to 7.5mg/325 from 5/325.

sometimes it is just easier to beat your head against a brick wall.

Uh, whoa.

firstly--you didn't order the pain med increase. the doctor did.

secondly--DON and NP don't know what they're talking about.

thirdly--if the patient was in pain (presumably why you contacted the doc in the first place), that needs to be addressed.

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Specializes in LTC/Rehab, Med Surg, Home Care.
i recently got called on the carpet by the DON and the NP for getting a patient increased pain meds from the doc on call for the pain associated with her shingles. both said that "shingles doesnt hurt THAT bad". seriously, they said that.

all i had done was gotten the order to increase the hydrocodone to 7.5mg/325 from 5/325.

sometimes it is just easier to beat your head against a brick wall.

I'm surprised that neurontin wasn't added instead of increasing the hydrocodone. So the DON and the NP know emperically what the pt felt? Very nice, lucky for them too...may they have such empathetic health care professionals when they are in pain.

Shingles varies in severity and in the pain that the pt. has. My son had shingles several years ago and had virtual no pain.

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