脉冲射频用于三叉神经疱疹后神经痛治疗的对比观察

目的:三叉神经带状疱疹后神经痛是头面部疼痛疾病中最有代表性的疾病之一,本文报道脉冲射频为主治疗三叉神经区疱疹后遗神经痛的效果.方法:本组共计疼痛科住院的三叉神经带状疱疹后神经痛患者30例,门诊患者30例,观察药物及脉冲射频治疗前、后疼痛程度和性质、患区遗留症状和睡眠质量.结果:患者主诉头面部自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛为主.激惹型42例,麻痹型18例,平均VAS评分为8.2分.药物组患者治疗后平均VAS评分为5.4分.经过加用2次脉冲射频治疗(2Hz,40℃,120s)平均VAS评分为3.3分.经过14-18个月的随访,脉冲射频组疗效稳定.结论:本组三叉神经疱疹后神经痛患者结果表明:加用脉冲射频治疗后大部分患者疼痛缓解明显,效果比较稳定,患者的生活质量明显改善.     

神经阻滞治疗带状疱疹神经痛临床疗效观察

目的 探讨神经阻滞在治疗带状疱疹神经痛及带状疱疹后神经痛(PNH)中的临床疗效.方法 总结我院麻醉科疼痛病房2003年3月至2007年10月所收治的167例带状疱疹神经痛及PNH患者,比较单纯药物治疗与合用神经阻滞治疗后疼痛缓解程度(VAS评分),自觉疼痛缓解程度评分、睡眠受影响率、并发症发生情况.结果 167例患者中,带状疱疹神经痛组(85例)中,单纯药物治疗后,VAS评分降低(1.61±1.8)分,72%患者仍存在中～重度疼痛;合用神经阻滞治疗后,VAS评分降低(4.14±2.17)分,63%患者睡眠改善.PNH组(82例)中,单纯药物治疗后,VAS评分降低(1.21±0.96)分,85%患者仍存在中～重度疼痛;合用神经阻滞治疗后,VAS评分降低(4.21±1.77)分,55%患者睡眠改善.结论 神经阻滞治疗对带状疱疹神经痛及PNH均有疗效.     

牛痘疫苗接种家兔炎症皮肤提取物及连续星状神经节注药治疗头面部疱疹后神经痛临床研究

目的:三叉神经带状疱疹后神经痛是头面部疼痛疾病中最为剧烈的疼痛疾病之一。本文报道使用牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平)及连续星状神经节注药(CSGB)对比药物治疗三叉神经区疱疹后遗神经痛的临床疗效分析。方法:本组40例患者,病程3个月~4年。使用VAS评分评价疼痛程度;使用改良HAMD评价抑郁程度;同时检查治疗前、后损伤区域红外热图。门诊(OP)组治疗方法:甲钴胺2 mg/日,神经妥乐平2~4片/日,加巴喷丁600~900 mg/日或普瑞巴林150~450 mg/日。住院(IP)组治疗方法:口服药同OP组,CSGB处方:0.1%罗哌卡因200 ml+神经妥乐平6 ml,连接PCA泵(ZBB-Ⅰ型,南通产),持续量0.5~1 ml/h,追加剂量0.5 ml/次,持续使用一周。两组患者均于治疗两周及随访一年后评价效果。结果:患者主诉头面部自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛为主。两组患者平均HAMD评分为21.8±3.8分,平均VAS评分为7.8±1.6分。经过治疗后OP组和IP组患者平均VAS评分分别为5.4±1.2:3.2±0.8分,HAMD评分为18.5±3.1:11.2±2.1分;复发率为45%:20%;治疗前、后局部红外热图平均差值为:1.2~5.8℃。IP组经过14~18个月的随访,疗效相对稳定。对于复发患者则采用其他方法进行治疗。结论:两组头面疱疹后神经痛患者初步结果表明:与OP组治疗结果比较,IP组加用CSGB方法安全,有效,能够快速控制剧烈疼痛,患区后遗症状大部分缓解。经过一年左右随访大部分患者效果稳定,生活质量明显改善。     

通络活血方治疗带状疱疹后遗神经痛的临床研究

目的:观察自拟通络活血方治疗带状疱疹后遗神经痛的临床疗效。方法:选择120例符合诊断标准的带状疱疹后遗神经痛患者,随机分成两组,治疗组采用通络活血方治疗,对照组采用桃红四物汤加减治疗,观察患者治疗前、后受累神经疼痛症状改善情况和治愈率。结果:治疗组神经疼痛症状减轻程度明显优于对照组(P<0.05);治疗组治愈率明显高于对照组(P<0.05)。结论:通络活血方能有效治疗带状疱疹后遗神经痛。     

正清风痛宁缓释片联合加巴喷丁胶囊治疗亚急性期带状疱疹后神经痛的临床观察

Dworkin和Portenoy[1]在1996年提出将带状疱疹分为急性期、亚急性期和慢性期3个阶段,其中病程1~3月的亚急性期以及病程超过3月的慢性期,合称为带状疱疹后神经痛(postherpetic neuralgia,PHN)。PHN是神经病理性疼痛(neuropathic pain,NP)的常见类型,也是带状疱疹最常见的并发症,有65%~75%的中老年带状疱疹病人会发展为PHN[2]。PHN具有自发性疼痛、痛觉过敏和痛觉超敏等特点,多呈烧灼样、针刺样或电击样疼痛,程度剧烈而持久[1]。长期疼痛的病人常伴随焦虑、抑郁、睡眠障碍等症状,严重影响病人身心健康及生活质量[3]。     

带状疱疹后遗神经痛风险因素的研究

目的:带状疱疹后遗神经痛(postherpetic neuralgia,PHN)是带状疱疹最常见的并发症之一,了解其发生的原因对指导临床治疗有重要的作用,本文旨在对可能引起带状疱疹发展为带状疱疹后神经痛的危险因素进行分析。方法:通过收集我科2009年1月至2011年3月共101例住院带状疱疹患者信息,定义PHN为出疹90天后仍有疼痛。将年龄、性别、早期治疗、疼痛程度、疱疹面积、高血压、糖尿病、免疫疾病等列为自变量,建立logistic回归模型,利用向前逐步法筛选出有统计学意义的变量。结果:研究数据的logistic回归分析显示,风险因素中年龄(P<0.0001,OR=1.125,95%CL1.062~1.191)、疼痛程度(P=0.0003,OR=5.598,95%CL)是带状疱疹后神经痛发生危险因素;疱疹位置(P=0.0069,OR=0.131,95%CL 0.030~0.573)、早期抗病毒治疗(P=0.0059,OR=0.019,95%CL 0.001~0.321)、抗病理神经痛治疗(P=0.0190,OR=0.136,95%CL 0.026~0.720)为有利因素。结论:重视高年龄、头面部带状疱疹的患者,早期进行抗病毒、抗病理神经痛治疗能有效预防疱疹后神经痛。     

早期脉冲射频治疗带状疱疹神经痛临床研究

目的:回顾性分析早期脉冲射频(pulsed radiofrequency,PRF)治疗对带状疱疹神经痛(zoster related neuralgia,ZRN)临床疗效的影响,为提高ZRN临床疗效和预防带状疱疹后神经痛(postherpetic neuralgia,PHN)提供依据.方法:2019年6月至2020年6...     

神经阻滞治疗老年带状疱疹后遗神经痛及其对免疫功能的影响

临床上认为带状疱疹的皮疹消退以后,其局部皮肤仍有疼痛不适,且持续1个月以上者称为带状疱疹后遗神经痛(postherpetic neuralgia,PHN)。据报导,带状疱疹发病率为人群的1.4‰～4.8‰之间,约有20%的患者遗留有神经痛。带状疱疹患者发展成PHN(带状疱疹后神经痛)的比例是随着患者的年     

椎旁脊神经根阻滞联合普瑞巴林治疗带状疱疹后神经痛的临床疗效

带状疱疹后神经痛(postherpetic neuralgia,PHN)是典型的周围性神经病理性疼痛,其疼痛程度剧烈,患者往往伴有失眠、抑郁烦躁等精神症状,严重影响患者生活质量.我科自2011年1月～2012年3月,收治带状疱疹后遗痛患者62例,予以椎旁神经阻滞联合普瑞巴林口服治疗,取得满意效果,特报告于下. 方法 1.一般资料 选择确诊带状疱疹后神经痛62例患者,男28人,女34人,年龄52 ～ 82岁,疱疹后疼痛分布区域为T4～L5脊神经节段支配区.治疗前患者均有程度不等的持续性、剧烈、顽固性、针刺闪电样痛史或痛觉过敏现象.同时排除:①患者合并有急性感染而控制不佳者;②穿刺部位有炎症及皮肤溃烂者;③凝血功能严重障碍者.两组患者治疗前一般资料无显著性差异(P＞0.05).     

C臂引导下椎间孔阻滞联合红外偏振光照射治疗40例胸腰部带状疱疹后遗神经痛

带状疱疹后遗神经痛(PHN)是急性带状疱疹愈合自然病程结束后仍存在后遗皮肤疼痛[1],多发于老年人,可持续数月至数年,疼痛程度剧烈,多呈烧灼样刺痛,顽固难除,严重影响患者的生活与工作.我科自2004年～2008年,应用椎间孔神经阻滞联合红外线偏振光治疗胸腰部带状疱疹后遗神经痛20例,效果满意,现报告如下.     

Factors influencing the features of postherpetic neuralgia and outcome when treated with tricyclics.

This paper retrospectively reviews features of postherpetic neuralgia (PHN) in up to 279 personal patients in relation to treatment outcome when treated with tricyclic antidepressants (TCAs). Factors affecting characteristics of PHN: (i) Patients with allodynia (89%) and/or burning pain (56%) have a much higher visual analogue pain intensity score than those without; (ii) Acyclovir (ACV) given for acute shingles (HZ) does not reduce the incidence of subsequent PHN, but reduces the pain intensity in PHN patients with allodynia; (iii) ACV given for acute HZ reduces the incidence of burning pain in subsequent PHN, but not of allodynia; (iv) ACV given for acute HZ reduces the incidence of clinically detectable sensory deficit in subsequent PHN. Factors affecting outcome of TCA-treated PHN: (i) The point in time at which TCA treatment is commenced is by far the most critical factor: started between 3 and 12 months after acute HZ onset, more than two-thirds obtain pain relief (NNT=1.8); between 13 and 24 months, two-fifths (41%) (NNT=3.6); and more than two years, one-third (NNT=8.3). Background and paroxysmal pain disappear earlier and are more susceptible of relief than allodynia. (ii) Twice as many (86%) of PHN patients without allodynia obtain pain relief with TCA treatment than those with (42%); (iii) the use of ACV for acute HZ more than halves the time-to-relief of PHN patients by TCAs; (iv) PHN patients with burning pain are significantly less likely to obtain pain relief with TCAs than those without (p<0.0001).     

The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia

The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia (PHN). Sympathetic blocks have been traditionally used for patients with herpes zoster and PHN with three different therapeutic goals: pain relief during acute herpes zoster, pain relief during PHN, and prevention of PHN by treating patients with acute zoster. The role of sympathetic blocks in herpes zoster and PHN remains controversial due to methodologic shortcomings in published studies and the limited current understanding of the role of the sympathetic nervous system in mediating pain. Current theories of the pathophysiology of PHN, the role of the sympathetic nervous system in herpes zoster and PHN, and published studies investigating use of sympathetic nerve blocks in herpes zoster and PHN are reviewed.     

Predictors of Postherpetic Neuralgia Among Patients With Herpes Zoster: A Prospective Study

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The main objectives of this study were to: 1) estimate the severity and duration of PHN; and 2) identify the predictors of PHN. From October, 2005 to July, 2006, 261 outpatients with HZ, aged ≥50, were recruited within 14 days of rash onset during the routine clinical practice of 83 physicians across Canada. Physicians documented HZ characteristics, treatments, general health, functional, and immune status. HZ pain was measured at recruitment and on days 7, 14, 21, 30, 60, 90, 120, 150, and 180 following recruitment. PHN was defined as a worst pain ≥3 persisting or appearing more than 90 days after rash onset. Predictors of PHN were obtained by hierarchical log-binomial regression. Twenty-two percent of 249 immunocompetent subjects with HZ developed PHN. Median duration of PHN was 77 days. Independent predictors of PHN included: older age, limitation in performing usual activities prior to HZ, and pain severity at recruitment. This study confirms that older age and greater acute pain severity are predictors of PHN, while functional status emerges as a novel independent predictor of PHN that deserves further exploration. These findings will contribute to optimal use of the HZ vaccine and testing of new therapies that might prevent PHN.     

Postherpetic Neuralgia: The Never-Ending Challenge

Abstract: Postherpetic neuralgia (PHN) is defined as pain that persists 1 to 3 months following the rash of herpes zoster (HZ). PHN affects about 50% of patients over 60 years of age and 15% of all HZ patients. Patients with PHN may experience two types of pain: a steady, aching, boring pain and a paroxysmal lancinating pain, usually exacerbated by contact with the involved skin. Herpes zoster is initially a clinical diagnosis, based on the observation of a typical dermatomal distribution of rash and radicular pain. HZ is pathologically characterized by inflammatory necrosis of dorsal root ganglia, occasionally associated with evidence of neuritis, leptomeningitis, and segmental unilateral degeneration of related motor and sensory roots. Although acyclovir has been used successfully as standard therapy for varicella zoster virus (VZV) infection in the past decade, resistant strains of VZV are often recognized in immunocompromised patients. Therapy with acyclovir and the use of corticosteroids have been reported to prevent PHN in up to 60% of HZ patients. Management of chronic pain in PHN is more problematic. The only therapy proven effective for PHN in controlled study is the use of tricyclic antidepressants, including amitriptyline and desipramine. There is good evidence of efficacy from randomized trials that gabapentin and pregabalin (new anticonvulsant drugs) are of benefit in the reduction of pain from PHN. As alternative therapies, topical agents such as capsaicin, lidocaine or opioid analgesic treatment may give satisfactory results. Interventions with low risk, such as transcutaneous electrical nerve stimulation (TENS), are appropriate. Evidence is scant for the value of surgical and procedural interventions in general, although there are numerous, small studies supporting the use of specific interventions such as nerve blocks, neurosurgical procedures, and neuroaugmentation. Although antiviral agents are appropriate for acute HZ, and the use of neural blockade and sympathetic blockade may be helpful in reducing pain in selected patients with HZ, there is little evidence that these interventions will reduce the likelihood of developing PHN. Postherpetic neuralgia remains a difficult pain problem. This review describes the epidemiology and pathophysiology of PHN and discusses proposed mechanisms of pain generation with emphasis on the various pharmacological treatments and invasive modalities currently available.     

Neuralgia and zovirax treatment of patients with herpes zoster

AIM: To estimate the occurrence of postherpetic neuralgia (PHN) arising after acute period of herpes zoster (HZ) and determination of zovirax efficiency in PHN prevention. MATERIALS AND METHODS: Of a total of 102 patients with HZ aged 17-89 years, 20 patients aged 26-83 years were given zovirax. RESULTS: Acute pain syndrome in PHN was observed in more that one-third of HZ patients. Patients over 60 years of age were more predisposed to PHN. Zovirax reduced the duration of acute rash and its healing, decreased the number of patients with zoster-associated pain and PHN patients. CONCLUSION: Zovirax is effective and safe in preventing PHN in HZ patients.     

Post-herpetic neuralgia: the relation of pain complaint, sensory disturbance, and skin temperature

Twelve otherwise healthy patients with longstanding postherpetic neuralgia (PHN) were prospectively studied using clinical examination, infrared thermography and response to local anesthetic skin infiltration. All had at least 2 of 3 possible components to their PHN pain: continuous, neuralgic, or allodynic. In patients with allodynia, maximal reported pain and the location of maximal allodynia on sensory examination were largely overlapping and were often warm thermographically. Areas of dense sensory loss and skin scarring without allodynia were usually cool thermographically. Local anesthetic skin infiltration produced substantial pain relief in all 9 patients (essentially complete relief in 7) with allodynia: the 3 patients with predominantly continuous pain were not relieved. In 7 of 8 skin infiltration responders, the same dose of lidocaine i.m. in the deltoid muscle also produced significant, though less complete pain relief. These results suggest that PHN patients can be divided into at least 2 clinical groups: those with predominantly continuous pain localized to a region of significant sensory loss and those in whom allodynia is the most prominent sensory disturbance. The latter group has pain localized to areas with relatively preserved sensation. The differences in clinical features and response to lidocaine suggest that there are at least 2 different mechanisms contributing to the pain of PHN.     

Use of S-LANSS,a Tool for Screening Neuropathic Pain,for Predicting Postherpetic Neuralgia in Patients After Acute Herpes Zoster Events: A Single-Center, 12-Month,Prospective Cohort Study

Postherpetic neuralgia (PHN) is one of the most severe sequelae of herpes zoster events. Several risk factors have been reported for PHN, including old age, severe skin rash, and intense pain. This study therefore aims to evaluate the usefulness of the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS) in conjunction with previously reported risk factors for predicting PHN. A group of herpes zoster patients (N = 305) were included in the cohort study. Subjects were asked for their demographic information, clinical symptoms and signs, intensity of pain by visual analog scale (VAS), and S-LANSS. They were followed up in clinical visits or via telephone for 12 months. Nineteen patients (6.2%) suffered from PHN in this study. Using logistic regression, 3 risk factors for PHN were identified: age ≥70 years, high VAS scores, and high S-LANSS scores. Prediction of PHN using VAS (≥8) and S-LANSS (≥15) criteria achieved a sensitivity of 78.9% and specificity of 78.0%. Prediction of PHN in elderly patients (≥70 years), using the criteria of VAS (≥6) and S-LANSS (≥15) as well, achieved 100% sensitivity and 57.1% specificity. S-LANSS could be a useful prediction tool for PHN, particularly if combined with previously well-known risk factors and VAS.PerspectiveAmong acute herpes zoster patients, subjects with characteristics of neuropathic pain showed high frequency of PHN. The tools for screening neuropathic pain like S-LANSS could be helpful for predicting PHN and enabling early intervention of pain management.     

Brain activity for spontaneous pain of postherpetic neuralgia and its modulation by lidocaine patch therapy

Postherpetic neuralgia (PHN) is a debilitating chronic pain condition, yet there is a lack of knowledge regarding underlying brain activity. Here we identify brain regions involved in spontaneous pain of PHN (n=11) and determine its modulation with Lidoderm therapy (patches of 5% lidocaine applied to the PHN affected body part). Continuous ratings of fluctuations of spontaneous pain during fMRI were contrasted to ratings of fluctuations of a bar observed during scanning, at three sessions: (1) pre-treatment baseline, (2) after 6h of Lidoderm treatment, and (3) after 2 weeks of Lidoderm use. Overall brain activity for spontaneous pain of PHN involved affective and sensory-discriminative areas: thalamus, primary and secondary somatosensory, insula and anterior cingulate cortices, as well as areas involved in emotion, hedonics, reward, and punishment: ventral striatum, amygdala, orbital frontal cortex, and ventral tegmental area. Generally, these activations decreased at sessions 2 and 3, except right anterior insular activity which increased with treatment. The sensory and affective activations only responded to the short-term treatment (6h of Lidoderm); while the ventral striatum and amygdala (reward-related regions) decreased mainly with longer-term treatment (2 weeks of Lidoderm). Pain properties: average magnitude of spontaneous pain, and responses on Neuropathic Pain Scale (NPS), decreased with treatment. The ventral striatal and amygdala activity best reflected changes in NPS, which was modulated only with longer-term treatment. The results show a specific brain activity pattern for PHN spontaneous pain, and implicate areas involved in emotions and reward as best reflecting changes in pain with treatment.