Acute pain presentations

An older woman with herpes zoster

Martine O’Neill



A 68-year-old woman presents with a two-day history of a painful shingles-like rash. How should she be managed initially and, if the pain does not resolve, in the long term?

Article Extract

Elaine is 68 years old and has been your patient for several years. Her medical history is brief: a moderately elevated cholesterol level, which is treated with atorvastatin 20 mg daily, and also osteoarthritis for which she underwent a right-sided total knee replacement without complication. She and her husband are retired and walk 2 km most days. They attend your practice every year for vaccination against influenza. Today, Elaine presents with a rash on her back in the right midthoracic region, extending anteriorly to the underside of her breast. She is also experiencing pain in the same area. You are concerned she may have herpes zoster (HZ).

Picture credit: © Izabela Habur/iStockphoto. Model used for illustrative purposes only.