P12S06: Shingles
Bottom line: Information on pain management for shingles was used to maintain the management plan
(adding anti-pain medication), and to persuade another health professional to
make this change. There were no information-related patient health outcomes (no follow-up yet).
Level 1 outcome (situational relevance): On June 23, 2008, P12 did a search at work, by themselves*. They
retrieved three information hits about pain management for shingles. The reported search
objectives were: to address a clinical question, and to share information with
a patient. I had a patient [a
woman in her seventies] with shingles who actually was still in a lot of pain
and the doctor wasnt really prescribing much for the pain or it wasnt
effective for the pain. I was trying to come up with a recommendation. [
] [So
I told the patient]: I think this [to treat shingles with Gabapentin or Lyrica] would be better
managing, and what Id like to do, is to get in touch with your doctor to make
that recommendation. According to P12, the information from
e-Therapeutics+ was in agreement with and equally relevant as the information
from another electronic resource (website for pain management).
Level 2 outcome (cognitive impact): Three hits were
associated with a report of positive cognitive impact (see table). Regarding confirmation, reassurance, and reminder, P12 stated: I already knew the Gabapentin and Lyrica were
quite effective [for neuropathic pain] and I just really wanted to have the tables
and the dosing so I could send a recommendation to the doctor.
Retrieved
information hits:
1) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Shingles Herpesvirus infection Figure 1: Management of herpes zoster(P12S06H01)
2) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Shingles Herpesvirus infection Herpes varicella-zoster virus Goals of therapy Prevent postherpetic neuralgia (see Neurologic
disorders: neuropathic pain) Figure 1: Management of
chronic peripheralneuropathic pain Printable version
(P12S06H02)
3) e-Therapeutics+ (CIRT): Therapeutics Tab Keyword: Shingles Herpesvirus infection Varicella zoster virus Pharmacologic choices Neurologic disorders: neuropathic pain Table 5:Drugs used in
neuropathic pain Printable version Gabapentin and Lyrica (P12S06H03)
Level 3 outcome
(information use): Information on pain management
for shingles was retrieved, and used to maintain (be more certain about) the
management plan (adding anti-pain medication), and to persuade another health
professional to make this change (information used as presented in
e-Therapeutics+). [The
information was retrieved] to be able to explain to the patient that this is
whats causing the pain, its a neuropathic kind of pain, these kinds of
medications have been shown to be effective in managing that kind of pain. [
]
I think they [the patient] were probably already receiving [
] one of the oral
antiviral [
] [and] that was the right thing to be doing. [
] [But] now, Im
suggesting to the doctor that he should think about using Gabapentin or Lyrica
[
] [to] be more aggressively managing the pain.
Level 4 outcome (patient health): There was no clear relationship between the information use and patient
health outcomes. There was no follow-up (yet) so we do not know whether the
treatment was prescribed or not.
Levels of outcome of information-seeking
|
Situational relevance |
Positive cognitive
impact |
Information use |
Patient health |
|
Address a clinical question Share information |
Reminded something Confirmed Reassured |
Persuade Be more certain |
No outcome |