Bridging the gap between guidelines and clinical practice: Physician management patterns of postherpetic neuralgia in the Tabuk region, Saudi Arabia

Abstract

Introduction: Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition following herpes zoster. Despite established guidelines, real-world management patterns remain poorly defined in Saudi Arabia.

Objective: To assess physician involvement, treatment practices, and perceived barriers in PHN management in the Tabuk region.

Methods: A cross-sectional survey was conducted among 113 physicians from multiple specialties. The questionnaire evaluated clinical involvement, use of pharmacologic and topical therapies, referral patterns, and psychosocial assessment practices. Descriptive statistics and categorical tests were applied.

Results: Only 36.3% of physicians reported routine involvement in PHN care, with significant variation across specialties (p< 0.001). Participation was highest among pain/palliative specialists (85.7%), neurologists (66.7%), and dermatologists (47.1%). Awareness of topical therapies was high (92.9%), but clinical use was lower (68.3%). Gabapentinoids (87.8%), tricyclic antidepressants (73.2%), and opioids (63.4%) were commonly prescribed. Key barriers included inefficient referral systems (70.7%), limited access to interventional procedures (68.3%), and lack of standardized protocols (61.0%). Although 95.1% recognized PHN’s quality-of-life impact, only 39.0% routinely assessed psychosocial burden.

Conclusions: PHN management in Tabuk shows limited physician involvement and systemic barriers. Despite high awareness of guidelines, implementation gaps persist, particularly in the use of topical therapy and psychosocial care. Strengthening referral systems and multidisciplinary approaches may improve care delivery.

Keywords

Postherpetic neuralgia / Herpes zoster / Neuropathic pain / Physician practice patterns / Referral systems / Pain management

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