加巴喷丁治疗原发性三叉神经痛的对照研究

目的探讨加巴喷丁治疗原发性三叉神经痛的疗效、安全性及耐受性。方法将68例原发性三叉神经痛患者随机分为加巴喷丁组和卡马西平组各34例,分别单用加巴喷丁和卡马西平治疗10周,观察并记录患者的疼痛程度(VAS)、用药剂量及不良反应等。结果加巴喷丁组治疗4周后原发性三叉神经痛显效率61.8%,总有效率88.2%,4周后疼痛程度较治疗前显著减轻;卡马西平组三叉神经痛显效率64.7%,总有效率为91.2%,2周后疼痛程度较治疗前显著减轻。2组疗效比较,差异无统计学意义(P0.05),卡马西平组起效时间较加巴喷丁组短(P0.01),但4周后疼痛程度无统计学意义(P0.05)。而加巴喷丁组不良反应发生率低。结论加巴喷丁治疗原发性三叉神经痛与卡马西平的疗效相当,且无严重的不良反应,值得推广应用。     

加巴喷丁治疗带状疱疹后遗神经痛的临床研究

目的探讨加巴喷丁治疗带状疱疹后遗神经痛的临床效果与安全性。方法带状疱疹后遗神经痛患者32例,随机分为2组,每组16例,均给常规药物治疗。在此基础上加巴喷丁组给予加巴喷丁,剂量自300-900 mg,最大增至1 200 mg/d,分3次口服;卡马西平组服用卡马西平100-300 mg/次,3次/d,剂量1 200 mg/d。2组疗程均为4周,分别于治疗前及治疗后1、2、4周采用视觉模拟评分（VAS）进行疼痛评估,评定治疗效果,同时观察患者的不良反应。结果2组患者VAS评分及疗效比较差异无统计学意义（P〉0.05）,但加巴喷丁组不良反应作用较少且轻微。结论带状疱疹后遗神经痛应用加巴喷丁治疗安全有效。     

加巴喷丁治疗带状疱疹后神经痛的疗效

目的观察加巴喷丁治疗带状疱疹后神经痛（PHN）的临床疗效和安全性。方法将84例PHN患者按入院的先后顺序分为2组：治疗组（加巴喷丁组,43例）和对照组（卡马西平组,41例）。治疗组采用加巴喷丁胶囊治疗,对照组采用卡马西平片治疗。观察2组治疗前,治疗后7、14、21和28dVAS评分、24h睡眠时间、临床疗效及不良反应的情况。结果治疗组总有效率明显高于对照组（97．7％比65．9％,P〈0．05）。治疗组治疗后7、14、21和28dVAS得分均较对照组明显下降（均P〈0．05）,而睡眠时间均较对照组增加（均P〈0．05）。治疗组出现嗜睡4例,眩晕3例,乏力2例,厌食3例;对照组出现嗜睡4例,眩晕4例,乏力3例,厌食2例。结论加巴喷丁治疗PHN疗效确切,不良反应少,有利于改善患者的睡眠质量及生活质量。     

加巴喷丁、卡马西平治疗原发性三叉神经痛的随机对照试验

目的:观察加巴喷丁和卡马西平治疗原发性三叉神经痛的临床疗效及安全性。方法:原发性三叉神经痛患者91例,采用双盲、随机对照,分为加巴喷丁组(n=46)和卡马西平组(n=45)。采用视觉模拟评分(VAS)评估患者用药前和用药后1、2、4周疼痛程度,同时观察患者的不良反应,并记录治疗前后血、尿常规和肝、肾功能等指标。结果:卡马西平组患者,与用药前VAS值[(72.80±7.58)mm]相比,用药后VAS值显著下降(P<0.01),加巴喷丁组患者,与用药前VAS值[(73.55±6.77)mm]相比,用药后VAS值也显著下降(P<0.01),用药后1、2、4周两组同时间的VAS差异无显著性。用药后1、2、4周两组同时间有效率差异无显著性。不良反应在加巴喷丁组(30.43%)低于卡马西平组(60.87%),两组有显著性差异(P<0.01)。结论:加巴喷丁治疗和卡马西平治疗原发性三叉神经痛是有效而安全的,加巴喷丁安全性优于卡马西平。     

加巴喷丁治疗三叉神经痛临床疗效观察

选取我院住治疗的58例原发性三叉神经痛患者,观察组和对照组各29例。观察组采用加巴喷丁进行治疗;对照组患者采用卡马西平进行治疗,10w后,分析两组患者的疼痛程度、用药剂量以及不良反应等情况。2w后,患者的疼痛程度与治疗前有明显减轻,对照组的起效时间要短于观察组,两组数据差异具有统计学意义(P<0.05)。观察组患者不良反应发生率要低于对照组(P<0.05)。原发性三叉神经痛应用加巴喷丁的治疗效果与卡马西平的治疗效果相当,且不良反应较少,值得推广。     

加巴喷丁与普瑞巴林治疗带状疱疹后神经痛的效果比较

目的观察加巴喷丁和普瑞巴林治疗带状疱疹后神经痛(post-herpetic neuralgia,PHN)的效果以及对患者睡眠的影响。方法 60例PHN患者按随机数字表法分为加巴喷丁组和普瑞巴林组各30例,分别给予加巴喷丁900 mg/d口服和普瑞巴林150 mg/d口服,疗程均为28天。观察治疗前后疼痛和睡眠的改善情况及药物不良反应。结果两组患者治疗后各时点与治疗前相比疼痛评分随时间下降,睡眠时间增加(P<0.05);普瑞巴林组治疗后各时点的疼痛视觉模拟评分(Visualanalogue scale,VAS)低于加巴喷丁组(P<0.05),24小时睡眠时间大于加巴喷丁组(P<0.05);两组未出现严重的药物不良反应,普瑞巴林组嗜睡发生率明显低于加巴喷丁组(P<0.05),其余不良反应发生率两组间比较差异均无统计学意义(P>0.05)。结论普瑞巴林治疗PHN更安全有效,优于加巴喷丁。     

加巴喷丁与卡马西平治疗糖尿病神经痛的临床疗效对比

目的 对比加巴喷丁和卡马西平治疗糖尿病患者神经痛的临床疗效和安全性.方法 46侧糖尿病合并神经性疼痛患者随机分为治疗组和对照组,各23例.治疗组给予加巴喷丁治疗,对照组给予卡马西平治疗.运用视觉模拟评分（VAS）和睡眠干扰（SI）评价患者疼痛改善情况,观察2组患者治疗前和治疗后6周疗效和不良反应.结果 治疗组和对照组总有效率分别为82.6％和73.9％,差异不具有统计学意义（P＞0 05）;治疗组和对照组患者治疗后VAS和SI相比治疗前均显著改善（P＜0.01）;治疗6周后,治疗组VAS和SI评分显著低于对照组（P＜0.05）;治疗组和对照组不良反应发生率差异不具有统计学意义（P＞0.05）.结论 相比卡马西平,加巴喷丁治疗糖尿患并发病神经痛患者的镇痛效果更为明显,不良反应轻微.     

元胡止痛滴丸联合加巴喷丁胶囊治疗带状疱疹后遗神经痛对患者症状的改善评价

目的观察元胡止痛滴丸联合加巴喷丁胶囊治疗带状疱疹后遗神经痛对患者症状的改善效果。方法选取2020年8月至2022年8月我院收治的80例带状疱疹后遗神经痛患者,采用电脑便利抽样将患者分为对照组和试验组各40例。给予对照组患者加巴喷丁胶囊进行治疗,试验组患者在对照组患者的基础上加用元胡止痛滴丸进行治疗。对比两组NRS评分、AIS评分、治疗总有效率和不良反应发生率。结果治疗1周、2周及4周后,试验组患者NRS评分显著低于对照组(P<0.05);试验组患者AIS评分显著低于与对照组(P<0.05);试验组治疗总有效率为90.00%,显著高于对照组的70.00%(P<0.05);两组药物不良反应发生率比较,无明显差异(P>0.05)。结论元胡止痛滴丸联合加巴喷丁胶囊治疗带状疱疹后遗神经痛的效果显著,能够快速有效缓解患者疼痛症状,改善患者睡眠质量,且安全性较高。     

超声药物透入联合加巴喷丁治疗胸背部带状疱疹后神经痛的疗效观察

目的:观察超声药物透入治疗联合口服加巴喷丁治疗胸背部带状疱疹后神经痛的疗效。方法:56例确诊为胸背部带状疱疹后神经痛的患者,采用数字表法随机均分为两组,对照组(n=28):单纯口服加巴喷丁;观察组(n=28):在口服药物的基础上联合疼痛区域的超声药物透入治疗。观察治疗后1天、7天、14天及28天时的视觉模拟评分(visual analogue scale,VAS)和情绪评分(emotional scale,ES)的变化,并记录并发症和不良反应的发生率。结果:两组治疗后各个时间段VAS均较治疗前明显降低(P<0.05),ES均较治疗前明显降低(P<0.05);观察组较对照组的VAS降低和ES降低更明显(P<0.05)。结论:超声药物透入治疗联合口服加巴喷丁治疗胸背部带状疱疹后神经痛效果确切,可以用于治疗带状疱疹后神经痛。     

拉莫三嗪与奥卡西平对原发性三叉神经痛患者疼痛和入睡质量的影响

目的:研究原发性三叉神经痛患者采用奥卡西平与拉莫三嗪两种药物联合进行治疗的临床效果。方法:抽取过去一段时期84例在延边医院接受药物治疗的原发性三叉神经痛患者,随机将其分为对照组和治疗组,平均每组42例。对照组采用奥卡西平进行治疗;治疗组采用奥卡西平与拉莫三嗪两种药物联合进行治疗。比较2组患者原发性三叉神经痛药物治疗总有效率、药物原因导致的不良反应、药物干预前后匹兹堡睡眠质量指数量表评分和疼痛程度VAS评分改善幅度。结果:治疗组患者原发性三叉神经痛药物治疗总有效率为90.5%,优于对照组的69.1%,组间差异显著(P0.05);仅有2例药物原因导致的不良反应,少于对照组的9例,组间差异显著(P0.05);药物干预前后匹兹堡睡眠质量指数量表评分和疼痛程度VAS评分改善幅度大于对照组,差异显著(P0.05)。结论:原发性三叉神经痛患者采用奥卡西平与拉莫三嗪两种药物联合进行治疗,能够在短时间内控制疼痛、改善睡眠,减少药物不良反应,缩短用药时间。     

The use of gabapentin for the treatment of postherpetic neuralgia

BACKGROUND: Varicella-zoster virus causes chickenpox and can reemerge later in life to cause herpes zoster or shingles. One of the most common and disabling complications of herpes zoster is postherpetic neuralgia (PHN). OBJECTIVES: This article reviews the current primary literature about the efficacy and tolerability of gabapentin for the treatment of PHN. Gabapentin pharmacokinetics and drug interactions are also reviewed. METHODS: A literature search in the English language was conducted using OVID Web, which contained the following databases: MEDLINE (1966-present), EMBASE (1980-2002), Current Contents/Clinical Medicine (1999-2002), Cochrane Controlled Trials Register (1898-present), Cochrane Database of Systemic Reviews (fourth quarter, 2002), and International Pharmaceutical Abstracts (1970-2002). Search terms used were postherpetic neuralgia; zoster; gabapentin; neuropathic pain; pain; pharmacoeconomic; cost; controlled clinical trial; randomized, controlled trial; postherpetic neuralgia and gabapentin; gabapentin and pain; treatment and postherpetic neuralgia; gabapentin and age; gabapentin and gender; gabapentin and ethnicity; and gabapentin and pharmacokinetics. RESULTS: Gabapentin displays nonlinear absorption kinetics, is minimally protein bound (< 3%), has a high mean (SD) volume of distribution (50.4 [8.0] L), and is excreted via the kidneys as unchanged drug. Two randomized, placebo-controlled, parallel-group, multicenter clinical trials demonstrated the effectiveness of gabapentin at doses of up to 3600 mg/d to significantly reduce pain (P < 0.01 and P < 0.001), improve sleep (P < 0.01), and improve some parameters on the Short Form-McGill Pain Questionnaire (P < 0.05). Dizziness and somnolence were the most common side effects leading to withdrawal from the trials. The recommended dosage in adults is 300 mg at bedtime on day 1,300 mg BID on day 2, and 300 mg TID on day 3, titrating up as needed to 2400 to 3600 mg/d. To reduce adverse events in patients with renal impairment, the dose should be adjusted based on the patient's creatinine clearance. CONCLUSIONS: Gabapentin appears to be effective and well tolerated for the short-term treatment of PHN. However, future controlled studies are needed to determine whether the effectiveness of gabapentin for PHN is maintained for > 2 months, to establish the optimal dose of gabapentin for PHN, and to compare the efficacy of gabapentin with that of other pharmacologic agents used for the treatment of PHN.     

神经妥乐平治疗带状疱疹后遗神经痛的临床研究

目的:研究神经妥乐平治疗带状疱疹后遗神经疼痛的疗效、方法和安全性.方法:将患者随机分为对照组和神经妥乐平不同剂量组(3.8u/日,10.8u/日),疗程14天.结果:神经妥乐平使带状疱疹后遗神经痛明显改善,并具有快速起效、长时间止痛作用.尤其神经妥乐平10.8u/日组,疗效显著.结论:神经妥乐平是治疗带状疱疹后遗神经痛有效和安全药物.     

Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases. 2001;32:1481–1486.

Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged‐related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella‐zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age‐related, disease‐related, and drug‐related decline in cellular immunity to VZV. VZV‐induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients. Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy. The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio‐frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain.     

Trigeminal postherpetic neuralgia responsive to treatment with capsaicin 8?% topical patch: a case report

Postherpetic neuralgia has been variably defined but is generally understood to be pain that persists for longer than a few months after an attack of herpes zoster. Pain persists for years in approximately 10 % of those afflicted with acute herpes zoster. The likelihood of postherpetic neuralgia increases with older age, severity of the zoster, trigeminal location, and other factors. Postherpetic neuralgia is a neuropathic pain and treatment usually involves sequential trials of topical and systemic drugs; a variety of other therapies may be considered in refractory cases. A new topical capsaicin 8 % patch has been approved for this indication based on the positive studies in patients with non-trigeminal postherpetic neuralgia. Experience with the use of the capsaicin 8 % patch for trigeminal distribution neuralgia is lacking. We report a case of trigeminal postherpetic neuralgia which was safely and effectively treated with capsaicin 8 % patch.     

老年带状疱疹后遗神经痛病人多维度协同护理效果观察

[目的]观察多维度协同护理在老年带状疱疹后遗神经痛病人中的应用效果。[方法]将84例带状疱疹后遗神经痛老年病人按照住院尾号单双号分为对照组(40例)和观察组(44例),对照组接受常规护理,观察组接受多维度协同护理干预,干预后对两组病人的焦虑、抑郁、疼痛情况及护理效果进行比较。[结果]干预后观察组病人焦虑与抑郁评分、疼痛评分均低于对照组,临床护理总有效率高于对照组,经比较差异均有统计学意义(P均0.05)。[结论]对带状疱疹后遗神经痛老年病人实施多维度协同护理,有利于改善病人的负性情绪,降低疼痛程度,提高临床护理疗效。     

带状疱疹后三叉神经痛临床及病理分析

目的：探讨带状疱疹后三叉神经痛的临床及病理特点。方法：对34例带状疱疹后三叉神经痛进行临床分析,7例行Dandy氏手术并取病理检查。结果：发病年龄50～60岁20例（59%）。右侧21例（62%）。累及三叉神经I支24例（71%）。并发角膜溃疡12例,角膜炎10例。疱疹后三叉神经痛24例的病理所见,三叉神经感觉根肿胀、轴突变性、节段性脱髓鞘,神经纤维内见淋巴细胞及中性粒细胞浸润。结论：带状疱疹后三叉神经痛是带状疱疹病毒感染所致的三叉神经感觉根急、慢性炎症所致。该病多发生于中老年人,右侧I支较多,易并发角膜溃疡及角膜炎。Dandy氏手术是治疗带状疱疹引起的顽固性三叉神经痛的有效方法。     

Herpes zoster and postherpetic neuralgia: prevention and management

The recognizable appearance and the dermatomal distribution of herpes zoster lesions usually enable a clinical diagnosis to be made easily. Herpes zoster and postherpetic neuralgia occur mainly in older patients. The role of the varicella vaccine in preventing herpes zoster is uncertain, but is being studied. There is evidence to support using antiviral therapy and possibly low-dose tricyclic antidepressants to prevent postherpetic neuralgia. There is good evidence that treating herpes zoster with antiviral medication is beneficial, particularly in patients older than 50 years with severe outbreaks. The use of steroids has an unfavorable risk-benefit ratio. In patients who develop postherpetic neuralgia, there is good evidence to support treatment with gabapentin and tricyclic antidepressants. More evidence for treatment with capsaicin cream, lidocaine patch, and opioids is needed. Intrathecal methylprednisolone is an option for patients with persistent pain.     

疼痛护理干预对带状疱疹后遗神经痛患者视觉模拟评分及睡眠质量的影响

目的:分析疼痛护理干预在带状疱疹后遗神经痛治疗中的应用效果及对患者疼痛程度和睡眠质量的影响。方法:选取2019年1月至2019年12月来安徽省蚌埠市第一人民医院接受带状疱疹后遗神经痛治疗的患者60例作为研究对象,随机分为观察组和对照组,每组30例。对照组患者接受护理,观察组患者接受疼痛护理干预,比较2组患者护理前后疼痛程度、睡眠质量、生命质量和护理满意率。结果:护理后观察组患者VAS评分和PSQI评分均明显低于对照组,SF-36评分明显高于对照组(P<0.05);观察组护理满意率为93.33%,对照组为80.00%,P<0.05。结论:疼痛护理干预可有效改善带状疱疹后遗神经痛患者的疼痛程度,对于提高患者的睡眠质量和护理满意率效果显著,值得推广应用。