Physical Medicine, Rehabilitation, and Pain Management (2023)

Physical Medicine, Rehabilitation, and Pain Management (1)

Shingles is the bane of many people over age 60. A viral condition that causes a painful rash, most often appearing around the ribcage, shingles is caused by thesame virus that causes chickenpox. If you had chickenpox as a child, you’re at a much higher risk of having shingles as you grow older.

And if you develop shingles, you can develop a complication called postherpetic neuralgia, in which shingles symptoms continue even after the shingles rash goes away.

AtCHOICE Pain & Rehabilitation Center, with multiple locations in Maryland,our teamof board-certified physical medicine and rehabilitation specialists can diagnose and recommend the appropriate treatment forpostherpetic neuralgia.

The basics of shingles and postherpetic neuralgia

Although anyone can get chickenpox, it’s more common in children and teens, especially those who haven’t received the chickenpox vaccine. Unfortunately, even after chickenpox is over, the varicella-zoster virus that caused the condition can remain dormant in the body for decades, emerging later in life as shingles. If the episode of shingles damages nerve tissue, this can result in postherpetic neuralgia.


For many people who develop shingles, it usually occurs after age 60. However, for people with a weakened immune system or who are being given immunosuppressants, it can occur earlier.

Shinglestypically shows up as a stripe of blisters wrapping around the left or right side of the ribcage. For some people, it can spread to other parts of the body, including the eyes, or start interfering with nerves and the signals sent to the brain.

Besides the blisters, the symptoms can include pain, extreme sensitivity, burning, and numbness. In most cases, a shingles outbreak lasts3-5 weeks.

Postherpetic neuralgia

If the symptoms of shingles — such as itching or burning sensations — don’t go away after the rash clears up, this is likely because the conditiondamaged nerve tissue. The resulting condition is called postherpetic neuralgia.

The symptoms often appear in the same places that were affected by the shingles outbreak. Postherpetic neuralgia can last up to three months and then fade away. However, it can also linger for as long as a year, and, in rare cases, become permanent.

Treating postherpetic neuralgia

Treating postherpetic neuralgia can take several forms, and it may require some trial and error to find a remedy that works for you. At CHOICE Pain & Rehabilitation Center, we have a complete array of treatment options, including:

  • Medications, including opioids, to manage pain
  • Nerve blocks (injections to stop constant signals to the brain)
  • Acupuncture, an alternative medicine option
  • Relaxation exercises to help you stop focusing on itching or burning sensations
  • Counseling and group therapy for chronic pain

If you’re suffering from postherpetic neuralgia,book an appointmentonline or over the phone with CHOICE Pain & Rehabilitation Center today. Our Maryland offices are located in Hyattsville, Gaithersburg, Lanham, Dundalk, Oxon Hill, Rosedale, and Olney, and we have two offices in Baltimore.


What does it mean when your doctor sends you to pain management? ›

Pain management is a medical specialty that deals with conditions causing pain. They can be acute or chronic in nature. They can range from back pain, neck pain, leg pain (radicular pain), to joint pain including the hip, shoulder and knee.

How many chances do you get at pain management? ›

The number of chances a person gets at pain management varies among clinics. Some clinics will discharge someone after a major breach in an opioid contract and issue warnings for more minor violations. Usually, doctors test for harmful drug use once per year to gauge compliance.

What is the match rate for PMR? ›

Matching into Physical Medicine and Rehabilitation as a DO is moderately competitive, with a 64% match rate and 33% of spots filled by DO Seniors in the 2022 Match. In 2022, 275 DO seniors applied for Physical Medicine and Rehabilitation; 176 matched. For more on the most DO-friendly specialties, see this article.

What happens if you break a pain management contract? ›

If you violate the rules within a pain contract, you may be blacklisted by your doctor, and will most likely no longer receive any medication from them. In turn, you'll also have a much harder time finding a doctor willing to take you on as a patient.

How do doctors know if you are in pain? ›

Because your physical structure can sometimes give clues about your ongoing pain, your healthcare provider will give you a thorough physical examination. During this exam, he will check the range of motion in your joints, analyze your posture, and look for any physical abnormalities that might contribute to your pain.

Why is pain management a priority? ›

Pain causes distress and suffering for people and their loved ones. Pain can also increase blood pressure and heart rate, and can negatively affect healing. Managing the pain helps ease suffering.

What does it mean to be red flagged by a doctor? ›

[4] The presence of red flags indicates the need for investigations and or referral. Essentially red flags are signs and symptoms found in the patient history and clinical examination that may tie a disorder to a serious pathology.

How hard is it to get a chronic pain diagnosis? ›

Making an accurate chronic pain diagnosis can be difficult. Multiple clinically relevant chronic pain types, with additional specific diagnoses, make it hard to determine the cause of a patient's chronic pain symptoms. In addition, different types of chronic pain share the same symptoms.

What if my doctor won't take my pain seriously? ›

If you feel your primary care doctor doesn't take your symptoms seriously, ask for a referral to a specialist or go to a different practice for a second opinion. A fresh set of eyes can be extremely helpful. Review how to present your symptoms factually, clearly, quickly, and without unnecessary minutiae.

How many interviews do you need to match PMR? ›

Application Process:

The goal is to obtain 10-12 interviews. Determining which programs and how many programs to include should be a discussion with your PM&R advisor.

Does PMR show up on MRI? ›

Of these MRI findings, enhancement of joint capsule or rotator cuff tendon and focal bone edema in the head of the humerus were significantly frequent in the patients with PMR.

Does PMR qualify for disability? ›

As disability evaluations involve considering the person's total health, someone with polymyalgia rheumatica may qualify when their other medical conditions are considered. It is important to inform the insurance company of all conditions that affect a person's ability to work.

What is the difference between pain medicine and pain management? ›

Management strategies are aimed at lowering the intensity of pain through the use of these modern tools. On the other hand, pain medicine is often used as a “quick fix” rather than a long-term management solution.

What does pain management often include? ›

Pain management approaches include medications, injections, therapy and exercise. Your provider may recommend one approach or a combination of several. Pain management plans help people with chronic (long-lasting) pain feel better and improve their quality of life.

How do you know if you need pain management? ›

7 Signs That Indicate You Need Pain Management
  1. You Experience Consistent Pain. ...
  2. Sharp Pain Begins To Expand To Other Areas. ...
  3. Pain Disrupts Your Daily Routine. ...
  4. Your Pain Lessened But Your Progress Plateaued. ...
  5. Over-The-Counter Medications Are Not Effective. ...
  6. You Are Unable To Sleep. ...
  7. You Experience An Injury.

When should you follow up for pain management? ›

The suggested interval is every 3 months or more frequently depending on the clinical scenario. During follow up appointments, clinicians should ask patients about their preferences for continuing opioids based on the effects of therapy on pain and function relative to any adverse effects experienced.


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