夹脊穴结合局部围针治疗带状疱疹后遗神经痛的Meta分析

背景：临床应用夹脊穴结合局部围针治疗带状疱疹后遗神经痛取得了良好的疗效,但其效果是否优于西药尚不明确。目的：系统评价夹脊穴结合局部围针治疗带状疱疹后遗神经痛的有效性。方法：计算机检索中国知网数据库、维普全文期刊数据库、中国生物医学文献数据库、Pubmed医学文献检索服务系统、美国斯坦福大学的Highwire数据库,手工检索南京中医药大学图书馆过刊资料库及相关会议论文集,检索时间为建库至2010-07,收集夹脊穴结合局部围针治疗带状疱疹后遗神经痛的临床随机对照试验,并按照循证医学原则对文献质量进行评价。统计学分析采用RevMan 4.2软件。采用总有效率、临床治愈率、疼痫目测类比评分、临床症状评分等作为结局评价指标。结果与结论：共纳入13个随机对照试验（共858例）。Meta分析结果显示,夹脊穴结合局部围针治疗带状疱疹后遗神经痛在总有效率[RR=1.26,95％C1（1.19,.34）]、临床治愈率[RR=1.93,95％C1（1.64,2.27）]、疼痛目测类比评分[WMD=3.13,95％C1（2.38,3.87）]方面明显优于对照组。总有效率分类比较显示,夹脊穴结合围针的效果与物理治疗差异无显著性意义[RR=1.60,95％C1（0.43,6.02）],但明显优于卡马西平[RR=1.45,95％C／（1.22,1.72）】。说明火脊穴结合局部围针治疗带状疱疹后遗神经痛的疗效优于西药,但尚需要更多高质量的随机双盲对照试验来进一步证实其疗效。     

电针夹脊穴配合刺络拔罐治疗30例带状疱疹后遗神经痛的临床疗效观察

选取2012年6月²013年4月我院收治的60例带状疱疹后遗神经痛患者,随机分为针罐组和西药组各30例。针罐组采用电针配合刺络拔罐法治疗,西药组采用西药治疗,对比两组临床疗效。结果针罐组中治愈25例,好转4例,无效1例,总有效率96.6%。西药组中治愈18例,好转5例,无效7例,总有效率73.34%。两组差异有统计学意义(P<0.05)。电针夹脊穴配合刺络拔罐治疗带状疱疹后遗神经痛,能有效减轻患者的疼痛症状,提高患者的生活质量。     

电针夹脊穴配合调制中频治疗老年带状疱疹后遗神经痛的临床观察

目的:观察电针夹脊穴配合调制中频治疗老年带状疱疹后遗神经痛的近、远期临床疗效。方法:随机将64例老年带状疱疹后遗神经痛患者分为观察组与对照组各32例,2组均采用局部病灶区围刺及电针治疗,观察组加用电针夹脊穴与调制中频电疗法,治疗前及治疗第5、10、15、20次后均采用视觉疼痛模拟评分(VAS)与汉密尔顿焦虑量表(HAMA)进行评定,并评价临床疗效,治疗后随访疼痛复发情况。结果:观察组与对照组的总有效率分别为93.75%、90.63%,差异无统计学意义,但观察组愈显率明显优于对照组(87.50%,68.75%,P0.05);治疗前与治疗后各时间点比较,2组的VAS和HAMA评分均有显著改善(P0.05),但观察组的治疗后各时间点VAS评分和治疗5、10次后HAMA改善情况均优于对照组(P0.05);治疗结束后1、2个月分别随访,均无疼痛复发情况。结论:电针夹脊穴配合调制中频电疗对改善老年带状疱疹后遗神经痛的症状较单一理疗更显著,且远期疗效稳定,适宜临床推广。     

套管针皮下留置及护理治疗带状疱疹后遗神经痛

目的：探讨套管针皮下留置及相应护理对带状疱疹后遗神经痛的疗效。方法：89例带状疱疹后遗神经痛患者分为置管组45例和对照组44例，均接受抗炎治疗，置管组选择最痛点，用套管针皮下留置6-48h，并给予相应护理。结果：置管组痊愈率和有效率（66．7％、97．8％）均显著高于对照组（25．0％，84．1％，P〈0．05）。结论：套管针皮下留置及相应护理可显著提高带状疱疹后遗神经痛的疗效，且患者耐受性好。     

围针联合偏振光照射治疗带状疱疹后遗神经痛的临床研究

目的观察围针联合偏振光照射治疗带状疱疹后遗神经痛的疗效。 方法选取2010年6月至2010年12月我院皮肤科收治诊断的带状疱疹后遗神经痛患者120例,按随机数字表法随机分为围针组、照射组和综合组,每组40例。围针组采用围针治疗,照射组采用偏振光照射治疗,综合组采用围针联合偏振光照射治疗。3组均分别于治疗后1,2和3周进行疗效评价。 结果在治疗2周后综合组分别与围针组、照射组比较,疼痛发作频率及疼痛程度的差异均有统计学意义（P＜0.05),疼痛平均时间及疼痛间歇平均时间的差异亦均有统计学意义（P＜0.01)。在治疗3周后综合组分别与围针组、照射组比较,疼痛平均时间、疼痛间歇平均时间、疼痛发作频率及疼痛程度的差异均有统计学意义（P＜0.01)。综合组分别与围针组、照射组在疼痛消除时间上比较,差异均有统计学意义（P＜0.01)。 结论围针联合偏振光照射治疗带状疱疹后遗神经痛有较好的疗效,与围针治疗及偏振光照射治疗相比,能更快缓解疼痛,且明显缩短病程。     

综合护理干预在带状疱疹后遗神经痛患者中应用效果的Meta分析

目的通过系统评价综合护理干预在带状疱疹后遗神经痛患者中应用效果,为临床提供循证参考。方法检索中国知网数据库、万方数据库、维普中文科技期刊数据库和中国生物医学文献数据库从建库至2016年5月带状疱疹后遗神经痛患者应用综合护理干预的随机对照试验研究,筛选合格研究后应用RevM an 5.3软件进行Meta分析。结果符合纳入标准的文献共4篇,352例患者满足纳入标准。Meta分析结果显示,带状疱疹后遗神经痛患者应用综合护理干预与常规护理对照组相比,疼痛改善有效率的合并效应量OR=6.59,95%的可信区间为(3.56,12.19),合并检验分析结果为Z=6.01,P0.00001,差异有统计学意义。结论综合护理干预在带状疱疹后遗神经痛患者中应用效果相对于常规护理更有效。由于纳入研究文献质量一般,尚需更多高质量的研究予以证实。     

脉冲射频治疗带状疱疹神经痛

带状疱疹(HZ)是由潜伏性水痘带状疱疹重新激活引起的,终生发病率为30%。疼痛是带状疱疹最常见和最令人虚弱的后遗症。带状疱疹后遗神经痛(PHN)的定义是带状疱疹皮疹发作后持续三个月以上的慢性疼痛。在30%的患者中,这种情况会持续一年以上。该Meta分析旨在阐明脉冲射频(PR)减轻带状疱疹后遗神经痛症状的疗效。这篇综述纳入了关于PHN患者的随机对照试验,这些试验将脉冲射频组与对照组的结果进行了比较。综述共纳入6项发表于2013~2019年的随机对照试验,最终的样本总数为504名受试者。     

火针治疗带状疱疹后遗神经痛有效性和安全性的系统评价

目的系统评价火针治疗带状疱疹后遗神经痛(PHN)的有效性和安全性。方法计算机检索PubMed、EMbase、The Cochrane Library、CNKI、WanFang Data、CBM和VIP数据库,搜集有关火针治疗PHN有效性和安全性的随机对照试验(RCT),检索时限均从建库至2021年6月5日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入31个RCT,包括2755例患者。Meta分析结果显示:火针与西药相比可降低PHN患者的VAS评分[SMD=-1.00,95%CI(-1.36,-0.63),P<0.00001];火针联合西药与单用西药相比,可提高总有效率[RR=1.15,95%CI(1.06,1.23),P=0.0003],降低VAS评分[SMD=-1.92,95%CI(-2.87,-0.97),P<0.0001]、SAS评分[SMD=-0.89,95%CI(-1.20,-0.59),P<0.00001]。火针与常规针刺相比,可降低VAS评分[SMD=-1.37,95%CI(-2.35,-0.39),P=0.006],缩短即刻止痛时间[SMD=-0.64,95%CI(-0.88,-0.39),P<0.00001]。与中药相比,火针联合中药可降低VAS评分[SMD=-1.00,95%CI(-1.53,-0.47),P=0.0002]、SDS评分[SMD=-1.59,95%CI(-1.18,-1.31),P<0.00001]、SAS评分[SMD=-1.79,95%CI(-2.08,-1.49),P<0.00001]。此外,试验组不良反应发生率明显低于对照组。结论现有证据表明,火针可明显减轻PHN患者的疼痛强度,缓解焦虑,提高生活质量。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。     

针灸治疗带状疱疹后遗神经痛研究进展

带状疱疹后遗神经痛（PHN）是带状疱疹皮损完全消退后,皮损局部遗留迁延不愈的神经痛或发展成为顽固性神经痛,可持续数月至数年。西药的疗效一般,且有副作用。近年临床广泛采用针灸治疗PHN,效果显著。现就相关资料综述如下。     

中西医结合治疗带状疱疹后遗神经痛疗效观察

目的观察中西药合用对带状疱疹后遗神经痛（PHN）的临床疗效。方法将符合诊断的83例PHN患者随机分为两组,中西药合用组（治疗组）43例、西药组（对照组）40例。西药组给予维生素B1片、维生素B12片、维生素E丸、消炎痛片口服治疗,治疗组在上述治疗基础上给予中药汤剂口服治疗。观察对比两组患者治疗效果。结果治疗组和对照组相比差异有统计学意义。结论中西药合用治疗PHN疗效确切显著,可推广应用。     

Acyclovir for treatment of postherpetic neuralgia: efficacy and pharmacokinetics

Postherpetic neuralgia is the most common complication of herpes zoster (shingles) in the immunocompetent host. Its mechanism is incompletely understood, but one postulate is that continuous replication of varicella-zoster virus (VZV) in nerve tissues may be responsible for the pain. If this is so, antiviral treatment could be advantageous. To test this hypothesis, we performed a randomized, double-blind, placebo-controlled trial of intravenous acyclovir (10 mg/kg every 8 h [q8h]) for 14 days, followed by oral acyclovir (800 mg q6h) for 42 days in 10 subjects (median age, 71 years) who had experienced at least 6 months of severe pain (median duration of postherpetic neuralgia before enrollment, 3.2 years). Intensive and sparse pharmacokinetic sampling occurred during both dosing phases of the study. One- and two-compartment models were fitted to the oral and intravenous concentration-time data, respectively. The four men and four women assigned to acyclovir during either or both dosing phases tolerated it well. Pharmacokinetic results were similar to those previously reported in younger individuals. The mean oral clearance and elimination half-life following oral dosing were 1.47 liters/h/kg and 2.78 h, respectively. Total clearance and terminal half-life following intravenous administration were 0.16 liters/h/kg and 3.67 h, respectively. Only 1 of 10 participants reported definite improvement in the severity of postherpetic pain, and treatment had no effect on titers of humoral antibody to VZV. We concluded that 56 days of intravenous and oral acyclovir therapy were well tolerated but had little or no effect on the clinical course of postherpetic neuralgia.     

带状疱疹后神经痛的综合物理治疗

目的完善带状疱疹后神经痛(PHN)的综合物理治疗方案。方法60例PHN患者,采用高电位全身治疗加脉冲短波和脉冲电磁分别置于病变部位对应的脊髓或神经节的体表投影区局部治疗,按简易McGiLL问卷计算治疗前后疼痛分数。结果治疗前(22·05±3·20)分,治疗后(1·50±1·46)分,t=26·3261,P<0·001。结论脉冲短波加脉冲电磁场于病变脊髓区或神经节体表投影区对置法与高电位疗法联合治疗带状疱疹后神经痛有效、安全。     

A novel treatment of postherpetic neuralgia using peppermint oil

BACKGROUND: Postherpetic neuralgia remains a difficult problem to treat. A number of therapies have been shown to be effective, but some patients have intractable pain. PATIENT: The case of a 76-year-old woman whose pain had been resistant to standard therapies is described. The pattern of quantitative sensory testing results for this patient led the authors to believe that she had an "irritable nociceptor" type of pathophysiology. INTERVENTION: The patient was instructed to apply neat peppermint oil (containing 10% menthol) to her skin, resulting in an almost immediate improvement in her pain. This pain relief persisted for 4-6 hours after application of the oil. RESULTS: The patient was successfully treated with topical peppermint oil. During 2 months of follow-up she has had only a minor side effect, with continuing analgesia. The authors believe this is the first evidence of peppermint oil (or menthol) having a strong analgesic effect on neuropathic pain. The possible mechanisms of action of peppermint oil are discussed.     

脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果

目的探讨脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果,为临床治疗该病提供参考依据。方法选取我科室于2017年2月至2020年2月收治的358例带状疱疹后遗三叉神经疼痛者为研究对象,以随机数字表法将其分为对照组和观察组,各179例。对照组给予普瑞巴林治疗,观察组给予脉冲射频刺激联合普瑞巴林治疗。比较两组的疼痛程度、机体神经肽水平、生活质量及治疗过程中的不良反应发生情况。结果治疗后1、2、3、4周,观察组的VAS评分均明显低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的SP、CGRP水平明显低于对照组,β-EP水平明显高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均较治疗前明显升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。两组患者治疗过程中的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论脉冲射频刺激联合普瑞巴林应用于带状疱疹后遗三叉神经痛的治疗中,可改善患者体内的神经肽水平,迅速缓解疼痛,提升生活质量,且不增加不良反应,安全性好,值得推广。     

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.     

围刺配合穴位注射甲钴胺对急性带状疱疹性神经痛的治疗作用

目的:探讨围刺及穴位注射甲钴胺对急性带状疱疹性神经痛(acute herpetic neuralgia,AHN)的作用。方法:招募了90名病人,随机数字法随机分为围刺组(n=31),穴位注射组(n=29)和联合组(n=30),接受2周治疗,治疗前后分别检测了疱液中白介素-2 (interleukins-2, IL-2),IL-4,P物质(substance P, SP)和降钙素基因相关肽(calcitonin gene-related peptide, CGRP)等指标。评定了皮肤愈合和疼痛改善及生活质量等项目。结果:三组病人治疗后临床指标均有明显改善(P <0.05),联合组效果更优(P <0.05)。治疗后三组中IL-4,SP和CGRP均较治疗前明显下降(P <0.05),而IL-2较治疗前明显增加(P <0.05),联合组更明显(P <0.05)。结论:围刺和穴位注射均对AHN有明确的治疗作用。两者结合效果更优,其机制可能与调节局部IL-2,IL-4,SP和CGRP的表达有关。     

中药祛痛汤结合多虑平治疗带状疱疹后遗神经痛疗效观察

目的：探讨中药祛痛汤结合多虑平治疗带状疱疹后遗神经痛（PHN）的临床效果。方法选择自2011年9月以来接诊的PHN患者90例,分为试验组和对照组,每组各45例。对照组患者采取常规西药治疗,肌肉注射维生素B1和B12以及多虑平;试验组在对照组的基础上再加上口服中药祛痛汤治疗。每个疗程10d,治疗持续3个疗程。治疗结束后立即采用视觉模拟评分法（VAS）对患者疼痛进行评分,比较两组治疗效果。结果试验组综合疗效评定为痊愈12例,显效18例,好转11例,无效4例,总有效率达到91．1％;对照组综合疗效评定为痊愈8例,显效14例,好转13例,无效10例,总有效率达到77．8％,两组有效率相比差异有统计学意义（P＜0．05）;两组患者不良反应比较差异无统计学意义（P＞0．05）。结论中药祛痛汤结合多虑平治疗PHN的效果明显,无明显不良反应,是PHN较佳的治疗选择之一,值得在临床上进一步推广。     

Amitriptyline and fluphenazine in the treatment of postherpetic neuralgia

BACKGROUND: Postherpetic neuralgia (PHN) is a vexing problem occurring in 10 to 20 percent of people with from herpes zoster (shingles). Anecdotal reports show that fluphenazine enhances the effects of amitriptyline for the treatment of PHN. The aim of this study was to determine, in a controlled manner, whether this was the case. METHODS: In a double-blind placebo-controlled study, 49 patients with PHN were randomly assigned to four treatment groups: Group 1, amitriptyline; Group 2, amitriptyline and fluphenazine; Group 3, fluphenazine; Group 4, a placebo. An active placebo was used to mimic the anticholinergic side effects of dry mouth. The study lasted 8 weeks, with weekly progress evaluations with use of visual analog scales (VAS), the McGill Pain Questionnaire (MPQ), and a side-effects scale. RESULTS: A statistically significant decrease was seen in pain in Groups 1 and 2, and no significant changes were seen in Groups 3 and 4. There was no significant difference when fluphenazine was added to amitriptyline. CONCLUSION: These data support the effectiveness of amitriptyline in treatment of PHN, but do not support the addition of fluphenazine.     

普瑞巴林联合经皮电刺激治疗带状疱疹后遗神经痛的疗效

目的：采用加拿大作业表现量表（COPM）分析脑卒中后肢体功能障碍患者作业活动需求,实施以患者为中心的治疗模式,观察疗效;并调查患者和康复治疗师应用COPM的体会。方法：脑卒中患者51例,均在人院时应用COPM全面评测作业活动需求,以此制定康复目标和治疗计划,实施以患者为中心的作业治疗模式;比较治疗前后作业活动的表现和满意度;同时发放调查问卷,调查患者和治疗师应用COPM的体会。结果：患者自理活动需求明显多于生产和休闲活动需求（P〈0．01）;作业活动表现评分和满意度评分均较治疗前明显提高（P〈0．05）;调查表明COPM涉及的问题更加细致、全面和实际,能够确认患者亟待解决的作业活动问题。结论：COPM简单易行,能确认患者亟待解决的作业活动,对临床治疗有指导意义。