脉冲射频联合普瑞巴林治疗带状疱疹神经痛临床研究
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摘要
目的:本研究探讨脉冲射频联合普瑞巴林早期治疗急性带状疱疹神经痛的临床效果,观察治疗后疼痛减轻程度及带状疱疹后神经痛(postherpetic neuralgia,PHN)的发生情况。方法:选择胸腰部带状疱疹神经痛病人150例,年龄60～89岁。用随机数字表法将病人随机分为3组,每组50例:普瑞巴林组,每日2次,每次口服普瑞巴林150mg;脉冲射频组,病损神经背根神经节接受脉冲射频治疗;脉冲射频+普瑞巴林组,每日普瑞巴林口服2次,每次150 mg,病损神经背根神经节接受脉冲射频治疗。用视觉模拟评分法(visual analogue scale,VAS)评定治疗前、治疗后1个月、 3个月的疼痛评分情况,记录3个月内镇痛药曲马多及普瑞巴林的用量和服药持续时间。用发生PHN的例数/总病例数评定3组PHN的发生率。结果:治疗后1个月、治疗后3个月射频联合普瑞巴林组VAS评分均低于普瑞巴林组(P<0.01)及射频组(P<0.01)。射频联合普瑞巴林组每日普瑞巴林口服药量小(P<0.05)且服药时间短(P<0.01),辅助镇痛药曲马多每日用量小(P<0.01),服药时间短(P<0.01)。与普瑞巴林组及射频组相比,射频联合普瑞巴林组PHN的发生率为3.92%。结论:脉冲射频联合普瑞巴林早期治疗急性期带状疱疹神经痛,可明显减轻疼痛并有效预防带状疱疹后神经痛的发生。
Objective: The purpose of this study was to investigate the effect of pulsed radiofrequency combined with pregabalin on acute herpes zoster neuralgia. The degree of pain relief and the occurrence of postherpetic neuralgia after treatment were recorded. Methods:One hundred and ?fty cases of thoracolumbar herpes zoster neuralgia were selected, aged from 60-89. The patients were randomly divided into three groups with 50 cases in each group. The ?rst group is Pregabalin group, and patients were orally given 150mg pregabalin each time, twice a day. The second is Pulsed Radiofrequency group. The damaged dorsal root ganglia were given pulsed radiofrequency therapy. The third is Pulsed Radiofrequency combined with Pregabalin group. Patients were given pregabalin(150mg each time, twice a day) and Pulsed Radiofrequency therapy on damaged dorsal root ganglia. The analgesic effect was evaluated by visual analogue scale(VAS) score before treatment, one months and three months after treatment. The dosage and duration of pregabalin and tramadol were recorded. The incidence of PHN was assessed with the number of cases occurring PHN/total number of cases. Results: One months after treatment and three months after treatment, the VAS score of Pulsed Radiofrequency combined with Pregabalin group was lower than that of Pregabalin group(P<0.01) and Radiofrequency group(P<0.01). Compared with Pregabalin group, the daily oral dose of pregabalin in Pulsed Rradiofrequency combined with Pregabalin group was smaller(P<0.05) and medication course was shorter(P<0.01). Meanwhile,compared with Pregabalin group, the daily oral dose of tramadol, an auxiliary analgesic, in Pulsed Rradiofrequency combined with Pregabalin group was smaller(P<0.01), and the medication course was shorter(P<0.01). In Pulsed Radiofrequency combined with Pregabalin group, the incidence of PHN was 3.92%. Conclusion: Pulsed Radiofrequency combined with Pregabalin in the treatment of acute herpes zoster neuralgia can signi?cantly reduce pain and effectively prevent the occurrence of postherpetic neuralgia.
Objective: The purpose of this study was to investigate the effect of pulsed radiofrequency combined with pregabalin on acute herpes zoster neuralgia. The degree of pain relief and the occurrence of postherpetic neuralgia after treatment were recorded. Methods:One hundred and ?fty cases of thoracolumbar herpes zoster neuralgia were selected, aged from 60-89. The patients were randomly divided into three groups with 50 cases in each group. The ?rst group is Pregabalin group, and patients were orally given 150mg pregabalin each time, twice a day. The second is Pulsed Radiofrequency group. The damaged dorsal root ganglia were given pulsed radiofrequency therapy. The third is Pulsed Radiofrequency combined with Pregabalin group. Patients were given pregabalin(150mg each time, twice a day) and Pulsed Radiofrequency therapy on damaged dorsal root ganglia. The analgesic effect was evaluated by visual analogue scale(VAS) score before treatment, one months and three months after treatment. The dosage and duration of pregabalin and tramadol were recorded. The incidence of PHN was assessed with the number of cases occurring PHN/total number of cases. Results: One months after treatment and three months after treatment, the VAS score of Pulsed Radiofrequency combined with Pregabalin group was lower than that of Pregabalin group(P<0.01) and Radiofrequency group(P<0.01). Compared with Pregabalin group, the daily oral dose of pregabalin in Pulsed Rradiofrequency combined with Pregabalin group was smaller(P<0.05) and medication course was shorter(P<0.01). Meanwhile,compared with Pregabalin group, the daily oral dose of tramadol, an auxiliary analgesic, in Pulsed Rradiofrequency combined with Pregabalin group was smaller(P<0.01), and the medication course was shorter(P<0.01). In Pulsed Radiofrequency combined with Pregabalin group, the incidence of PHN was 3.92%. Conclusion: Pulsed Radiofrequency combined with Pregabalin in the treatment of acute herpes zoster neuralgia can signi?cantly reduce pain and effectively prevent the occurrence of postherpetic neuralgia.
引文
[1]Johnson RW,Dworkin RH.Treatment of herpes zoster and post herpetic neuralgia[J].BMJ,2003,326(7392):748-750.
[2]Kawai K,Gebremeskel BG,Acosta CJ.Systematic review of incidence and complications of herpes zoster:towards a global perspective[J].BMJ Open,2014,4(6):1-18.
[3]Kanazi GZ,Johnson RW,Dworkin DRH.Treatment of Postherpetic Neuralgia:An Update[J].Drugs,200059(5):1113-1126.
[4]Kim HJ,Ahn HS,Lee JY,et al.Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster:a systematic review and meta-analysis[J].Korean J Pain,2017,30(1):3-17.
[5]Johnson RW,Rice AS.Clinical practice:Postherpetic neuralgia[J].N Engl J Med,2014,371(16):1526-1533.
[6]高崇荣,樊碧发,卢振和.神经病理性疼痛诊疗学[M].北京:人民卫生出版社,2013,22(2):662-671
[7]于生元,万有,万琪,等.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志,2016,22(3):161-167.
[8]Kim ED,Lee YI,Park HJ.Comparison of efficacy of continuous epidural block and pulsed radiofrequency to the dorsal root ganglion for management of pain persisting beyond the acute phase of herpes zoster[J].Plos One,2017,12(8):1-13.
[9]赵志奇.带状疱疹痛:基础和临床[J].中国疼痛医学杂志,2014,6(20):369-375.
[10]Forbes HJ,Thomas SL,Smeeth L,et al.A systematic review and meta-analysis of risk factors for postherpetic neuralgia[J].Pain,2016,157(1):30-54
[11]Bockbrader HN,Wesche D,Miller R,et al.A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin[J].Clin Pharmacokinet2010,49(10):661-669.
[12]Finnerup NB,Attal N,Haroutounian S,et al.Pharmacotherapy for neuropathic pain in adults:a systematic review and meta-analysis[J].Lancet Neurol,201514(2):162-173.
[13]魏星,王家双,包佳巾.脉冲射频用于三叉神经疱疹后神经痛治疗的对比观察[J].中国疼痛医学杂志2011,17(4):205-207.
[14]Ke M,Yinghui F,Yi J,et al.Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae:A randomized,double-blinded,controlled trial[J].Pain Physician,2013,16(1):15-25.
[15]Liem L,van Dongen E,Huygen FJ,et al.The dorsal root ganglion as a therapeutic target for chronic pain[J]Reg Anesth Pain Med,2016,41(4):511-519.
[16]Kim K,Jo D,Kim E.Pulsed Radiofrequency to the Dorsal Root Ganglion in Acute Herpes Zoster and Postherpetic Neuralgia[J].Pain Physician,2017,20(3):E411-418.
[2]Kawai K,Gebremeskel BG,Acosta CJ.Systematic review of incidence and complications of herpes zoster:towards a global perspective[J].BMJ Open,2014,4(6):1-18.
[3]Kanazi GZ,Johnson RW,Dworkin DRH.Treatment of Postherpetic Neuralgia:An Update[J].Drugs,200059(5):1113-1126.
[4]Kim HJ,Ahn HS,Lee JY,et al.Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster:a systematic review and meta-analysis[J].Korean J Pain,2017,30(1):3-17.
[5]Johnson RW,Rice AS.Clinical practice:Postherpetic neuralgia[J].N Engl J Med,2014,371(16):1526-1533.
[6]高崇荣,樊碧发,卢振和.神经病理性疼痛诊疗学[M].北京:人民卫生出版社,2013,22(2):662-671
[7]于生元,万有,万琪,等.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志,2016,22(3):161-167.
[8]Kim ED,Lee YI,Park HJ.Comparison of efficacy of continuous epidural block and pulsed radiofrequency to the dorsal root ganglion for management of pain persisting beyond the acute phase of herpes zoster[J].Plos One,2017,12(8):1-13.
[9]赵志奇.带状疱疹痛:基础和临床[J].中国疼痛医学杂志,2014,6(20):369-375.
[10]Forbes HJ,Thomas SL,Smeeth L,et al.A systematic review and meta-analysis of risk factors for postherpetic neuralgia[J].Pain,2016,157(1):30-54
[11]Bockbrader HN,Wesche D,Miller R,et al.A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin[J].Clin Pharmacokinet2010,49(10):661-669.
[12]Finnerup NB,Attal N,Haroutounian S,et al.Pharmacotherapy for neuropathic pain in adults:a systematic review and meta-analysis[J].Lancet Neurol,201514(2):162-173.
[13]魏星,王家双,包佳巾.脉冲射频用于三叉神经疱疹后神经痛治疗的对比观察[J].中国疼痛医学杂志2011,17(4):205-207.
[14]Ke M,Yinghui F,Yi J,et al.Efficacy of pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia from the angulus costae:A randomized,double-blinded,controlled trial[J].Pain Physician,2013,16(1):15-25.
[15]Liem L,van Dongen E,Huygen FJ,et al.The dorsal root ganglion as a therapeutic target for chronic pain[J]Reg Anesth Pain Med,2016,41(4):511-519.
[16]Kim K,Jo D,Kim E.Pulsed Radiofrequency to the Dorsal Root Ganglion in Acute Herpes Zoster and Postherpetic Neuralgia[J].Pain Physician,2017,20(3):E411-418.