A standardized nursing-led protocol integrating pain assessment, sleep monitoring, medication-adherence support, and digital symptom monitoring produced larger improvements in pain, sleep, medication adherence, and symptom burden compared to usual care alone in adults with postherpetic neuralgia over eight weeks.
Key Findings
Results
The protocol group showed greater reductions in NRS pain scores compared to the usual-care group at Week 8.
Mean NRS scores decreased from 7.28 ± 1.05 to 3.24 ± 1.28 in the protocol group versus from 7.19 ± 1.08 to 4.82 ± 1.53 in the usual-care group.
Baseline NRS scores were similar between groups, supporting comparability at enrollment.
The study was an eight-week prospective, parallel-group randomized controlled trial with 128 adults allocated 1:1.
Week-8 data were available for 116 participants (57 usual care; 59 protocol), indicating some attrition from the original 128 randomized.
Results
A clinically meaningful pain reduction of at least 2 NRS points was achieved by a substantially higher proportion of protocol participants than usual-care participants.
76.3% of protocol-group participants achieved an NRS reduction of at least 2 points by Week 8.
49.1% of usual-care participants achieved the same threshold.
This represents a difference of approximately 27 percentage points between groups.
The ≥2-point NRS reduction is a commonly used threshold for clinically meaningful pain relief.
Results
The protocol group showed larger improvements in sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI).
PSQI was one of the prespecified secondary outcomes.
The protocol integrated structured sleep monitoring as one of its four core components.
The abstract reports the protocol group showed 'larger improvements in PSQI' compared to usual care.
Specific PSQI score values and effect sizes are not reported in the abstract.
Results
Medication adherence, measured by MMAS-8, improved more in the protocol group than in the usual-care group.
MMAS-8 (Morisky Medication Adherence Scale-8) was a prespecified secondary outcome.
Medication-adherence support was one of the four integrated components of the nursing-led protocol.
The abstract states the protocol group showed 'larger improvements in MMAS-8' without providing specific scores.
The intervention lasted eight weeks.
Results
The protocol group experienced fewer breakthrough-pain episodes and lower rescue-analgesic use compared to the usual-care group.
Breakthrough pain episodes and rescue analgesic use were prespecified secondary outcomes.
Pain-related nocturnal awakenings were also reduced more in the protocol group.
Rule-based digital symptom monitoring was one component of the protocol intended to detect symptom fluctuations.
Specific counts or frequencies of breakthrough-pain episodes and analgesic use are not provided in the abstract.
Methods
The standardized nursing-led protocol integrated four core components delivered over eight weeks as an addition to usual care.
The four components were: structured pain assessment, sleep monitoring, medication-adherence support, and rule-based digital symptom monitoring.
128 adults with PHN were randomized 1:1 to usual care alone or usual care plus the protocol.
The trial design was a prospective, parallel-group randomized controlled trial.
Secondary outcomes included symptom burden, nocturnal awakenings, breakthrough pain, rescue analgesic use, adverse events, rule-based alerts, and nursing satisfaction.
Conclusions
The authors concluded that these findings support further evaluation in preregistered multicenter trials with intention-to-treat analyses and longer follow-up.
The current trial had 116 completers out of 128 randomized, and the abstract does not report intention-to-treat analysis.
The study was conducted at what appears to be a single center based on the abstract.
Follow-up extended only to Week 8, which the authors acknowledge as a limitation by calling for longer follow-up.
The recommendation for preregistered multicenter trials suggests the authors view this as preliminary evidence.
What This Means
This research suggests that adding a structured, nurse-led care program to standard treatment for postherpetic neuralgia (a chronic nerve pain condition that can follow shingles) leads to meaningfully better outcomes over eight weeks. The program combined regular pain check-ins, sleep tracking, help with taking medications correctly, and a digital monitoring system that flagged concerning symptoms. Compared to patients receiving usual care only, those in the program had pain scores that dropped roughly 1.5 points more on a 0–10 scale, and more than three-quarters of program participants achieved a meaningful pain reduction (at least 2 points) versus about half of usual-care participants. The program group also slept better, took their medications more consistently, had fewer episodes of sudden pain flares, and used fewer rescue pain medications.
Postherpetic neuralgia is notoriously difficult to manage because it involves not just pain but also sleep disruption, difficulty sticking to medication regimens, and unpredictable symptom changes—problems that standard medical visits may not fully address. This research suggests that a coordinated nursing protocol that targets all of these issues together, rather than treating them separately, may offer added benefit beyond conventional care alone.
However, the study was relatively small (128 participants, with 116 completing the eight weeks) and conducted over a short timeframe, and the authors themselves call for larger, multi-site trials with longer follow-up before broad conclusions can be drawn. These results should therefore be viewed as promising preliminary evidence rather than definitive proof, and future rigorous trials are needed to confirm whether this approach works across different healthcare settings and patient populations.
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Feng J, Fan X, Tang M, Liu Y, Sun L. (2026). A Standardized Nursing-Led Protocol Integrated Pain, Sleep, Medication Adherence, and Symptom Management in Postherpetic Neuralgia.. Journal of visualized experiments : JoVE. https://doi.org/10.3791/71714