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。     

神经阻滞联合普瑞巴林治疗带状疱疹后神经痛的研究

目的比较单纯口服普瑞巴林和联合神经阻滞两种方法治疗带状疱疹后神经痛(PHN)的效果。方法 60例病程超过6个月的PHN患者分成两组,每组各30例。A组口服普瑞巴林;B组在口服药物的基础上行神经阻滞(三叉神经、肋间神经、椎旁阻滞或腰丛阻滞)。比较两组患者治疗前、治疗后3 d、1周、2周、3周、4周、5周、6周、7周、8周疼痛视觉模拟评分(VAS)和睡眠评分(采用汉密尔顿抑郁量表的第4、5、6项)。比较两组患者疼痛缓解>50%和>30%的人数,以及副作用的发生率。结果两组患者治疗后1~8周VAS和睡眠评分均低于治疗前(P<0.05),B组患者在治疗后3 d VAS及睡眠评分明显低于A组(P<0.01);B组患者疼痛缓解>50%的人数和疼痛缓解>30%的人数高于A组(P<0.05)。两组患者副作用无显著性差异。结论神经阻滞联合口服普瑞巴林治疗带状疱疹后神经痛起效快、止痛作用强,无严重副作用发生。     

脉冲射频联合普瑞巴林治疗带状疱疹神经痛临床研究

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。     

普瑞巴林联合红光照射治疗带状疱疹后遗神经痛的疗效观察

选取我院2013年1月~2014年7月收治的80例带状疱疹后遗神经痛患者作为研究对象,随机将其分为研究组和对照组各40例。对照组采用口服普瑞巴林治疗,研究组在对照组的基础上给予红光照射治疗,观察和对比两组患者的临床疗效。结果治疗3、9w后,研究组患者的疼痛发生率明显低于对照组,均有统计学意义(P<0.05)。研究组患者的VAS评分明显低于对照组,均有统计学意义(P<0.05)。经治疗后,两组患者的HAMD评分与治疗前比较均有显著降低,有统计学意义(P<0.05)。两组的HAMD评分对比差异无统计学意义(P>0.05)。对带状疱疹后遗神经痛患者采用普瑞巴林联合红光照射进行治疗具有非常不错的临床疗效,可以明显降低患者的疼痛发生率、VAS评分和HAMD评分,非常值得在临床上进一步推广。     

普瑞巴林联合神经阻滞治疗带状疱疹后神经痛疗效观察

带状疱疹后神经痛（PHN）是带状疱疹治愈后在原皮损区域出现较长时间（病程〉1个月）剧烈的电击样、撕裂样疼痛,严重影响患者的生活质量,且目前无理想的治愈方法。国内有很多文献报道运用神经阻滞治疗PHN,取得较好疗效,但仍有部分患者疼痛未缓解。本院于2011年1月至3月应用普瑞巴林联合神经阻滞治疗PHN患者,取得良好疗效,报道如下。     

普瑞巴林联合神经阻滞在老年人头面颈部带状疱疹后神经痛中的应用

目的观察不同剂量普瑞巴林联合神经阻滞治疗老年人头面部带状疱疹后神经痛的有效性和安全性。方法头面部带状疱疹后神经痛老年患者54例,随机分为低剂量组和高剂量组。高剂量组采用三叉神经分支阻滞和皮损区皮内注射治疗每星期一次,治疗1个月,并从治疗开始时口服普瑞巴林300 mg/d,bid直至第10周,低剂量组采用相同的神经阻滞疗法并从治疗开始时口服普瑞巴林150 mg/d,bid直至第10周。用视觉模拟评分(visual analoguescale,VAS)和睡眠质量评分(quality of sleep,QS)评价治疗效果,并观察治疗后的不良反应。结果与治疗前比较,两组治疗后第1～10w,VAS和QS评分均显著下降(P<0.05);与低剂量组相比,高剂量组治疗后第5w和第4w开始VAS评分和QS评分分别降低,且差异有统计学意义(P<0.05);两组患者治疗后10周,不良反应无明显差别。结论普瑞巴林300 mg/d联合神经阻滞可迅速缓解老年头面部带状疱疹后神经痛,改善睡眠质量,且无明显不良反应,值得临床推广。     

普瑞巴林联合盐酸羟考酮治疗带状疱疹后神经痛的疗效观察

目的 探讨普瑞巴林联合盐酸羟考酮治疗带状疱疹后神经痛(post herpetic neuralgia,PHN)的临床疗效.方法 选取辽宁省人民医院2018年7月至2020年7月收治的100例PHN患者,按照随机数字表法分为观察组与对照组,每组50例,对照组给予盐酸羟考酮治疗,观察组采用普瑞巴林联合盐酸羟考酮治疗,比较两...     

普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的疗效

目的观察普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛的效果。方法 45例带状疱疹后三叉神经痛患者随机分为观察组和对照组,对照组采用口服普瑞巴林胶囊,观察组在对照组的基础上加用神经阻滞法。治疗4周后采用视觉模拟评分(VAS)和睡眠质量评分(PSQI)评价临床疗效。结果 2组患者治疗前及治疗1周后VAS评分和PSQI评分均无显著差异(P0.05),但治疗第2、3、4周,2组患者VAS评分和PSQI评分均显著降低,且观察组较对照组降低更为显著,差异有统计学意义(P0.05)。结论普瑞巴林联合神经阻滞治疗老年带状疱疹后三叉神经痛效果好,操作简单,值得临床应用。     

普瑞巴林治疗急性期带状疱疹的临床疗效

目的探讨普瑞巴林治疗带状疱疹急性期神经痛的有效性及其对后遗神经痛的影响。方法将106例带状疱疹急性期患者按治疗方法不同分为3组:对照组24例给予泛昔洛韦、维生素B1、甲钴胺等综合治疗;治疗Ⅰ组42例、治疗Ⅱ组40例在对照组治疗基础上给予普瑞巴林治疗,治疗Ⅰ组第1天早、晚各75 mg,第2天早、晚各150mg,治疗Ⅱ组从第1天开始即早、晚各服用150mg,3组疗程均为4周。比较2组的临床疗效与治疗期间不良反应发生情况,采用视觉模拟评分法(VAS)、阿森斯失眠量表(AIS)评价2组治疗前后疼痛程度及睡眠质量改善情况,治疗后随访3个月,观察2组后遗神经痛的发生率。结果治疗Ⅰ组、Ⅱ组治疗总有效率均显著高于对照组(P<0.05),治疗Ⅰ组与治疗Ⅱ组间比较差异无统计学意义(P>0.05)。3组患者治疗后VAS、AIS评分均较治疗前显著降低(P<0.05或P<0.01),且治疗Ⅰ组、Ⅱ组明显低于对照组治疗后(P<0.05),而治疗Ⅰ组、Ⅱ组比较差异无统计学意义(P>0.05)。治疗Ⅰ组、Ⅱ组后遗神经痛发生率均显著低于对照组(P<0.05),治疗Ⅰ组、Ⅱ组比较差异无统计学意义(P>0.05)。结论普瑞巴林治疗带状疱疹急性期具有镇痛效果好,起效快,安全可靠等优点,能改善患者疼痛的严重程度和睡眠质量,避免发生后遗神经痛的并发症;且不同加量方法不影响其临床疗效。     

普瑞巴林治疗枕神经痛的临床疗效观察

目的观察普瑞巴林治疗枕神经痛的疗效及安全性。方法将80例枕神经痛患者,随机分为治疗组（n=40）和对照组（n=40）。对照组常规予以非甾体类消炎镇痛药、活血化瘀及B族维生素等治疗,治疗组在此基础上加用普瑞巴林75~150 mg,2次/d。2组均观察3周,分别于治疗前及治疗后的1、2、3周进行自评、医评分值评价和临床疗效评价,判断普瑞巴林的疗效及安全性。结果 2组治疗前自评和医评分值比较。差异无统计学意义（P〉0.05）;2组治疗后1、2、3周,治疗组与对照组自评和医评分值比较,差异有统计学意义（P〈0.05）;临床疗效：治疗组有效率92.5%;对照组有效率52.5%,2组比较差异有统计学意义（P〈0.05）。两组均未发现严重副作用。结论普瑞巴林能有效改善枕神经痛患者的临床症状,副作用小,值得临床推广应用。     

Efficacy and Safety of Carisbamate in Patients with Diabetic Neuropathy or Postherpetic Neuralgia: Results from 3 Randomized,Double‐Blind Placebo‐Controlled Trials

The results of 3 proof‐of‐concept studies to evaluate carisbamate's efficacy and safety in treating neuropathic pain are presented. In studies 1 (postherpetic neuralgia, n = 91) and 2 (diabetic neuropathy, n = 137), patients received carisbamate 400 mg/day or placebo for 4 weeks and then crossed over to the other treatment for 4 weeks. In study 3 (diabetic neuropathy, higher carisbamate doses), patients (n = 386) were randomized (1:1:1:1) to receive either carisbamate 800 mg/day, 1200 mg/day, pregabalin 300 mg/day or placebo for 15 weeks. Primary efficacy end point was the mean of the last 7 average daily pain scores obtained on days the study drug was taken, for all 3 studies. Least square mean (95% CI) differences between carisbamate and placebo groups on the primary end point were as follows: study 1: ?0.512 (?1.32, 0.29) carisbamate 400 mg/day; study 2: ?0.307 (?0.94, 0.33) carisbamate 400 mg/day; and study 3: ?0.51 (?1.10, 0.08), carisbamate 800 mg/day; ?0.55 (?1.13, 0.04), carisbamate 1200 mg/day; and ?0.43 (?1.01, 0.15), pregabalin 300 mg/day. Neither carisbamate (all 3 studies) nor pregabalin (study 3) significantly differed from placebo, although multiple secondary end points showed significant improvement in efficacy with carisbamate in studies 1 and 2. Dizziness was the only treatment‐emergent adverse event occurring at ≥10% difference in carisbamate groups versus placebo (study 1: 12% vs. 1%; study 3: 14% vs. 4%; study 2: 1% vs. 2%). Carisbamate, although well tolerated, did not demonstrate efficacy in neuropathic pain across these studies, nor did the active comparator pregabalin (study 3).     

Pregabalin for peripheral neuropathic pain: results of a multicenter, non-comparative, open-label study in Indian patients

The aim of this study was to evaluate the tolerability, safety and efficacy of pregabalin in Indian patients with peripheral neuropathic pain. In this prospective, multicenter, non-comparative, open-label study, patients with peripheral neuropathic pain (n = 111) received pregabalin in doses ranging from 75 to 300 mg twice daily for 3 weeks. Primary efficacy measures included weekly pain score and the Visual Analogue Scale (VAS) score of the Short-Form McGill Pain Questionnaire (SF-MPQ). Despite a short study duration, a significant reduction was seen in weekly pain score (p < 0.0001), as well as VAS score of SF-MPQ (p < 0.0001). Significant improvements were also seen in other pain-related endpoints, weekly sleep interference score, quality of life measures, and patient and clinician ratings of global improvement. Pregabalin was well tolerated, and the most common adverse events were dizziness and somnolence. The short study duration precluded the assessment of longer term safety issues such as weight gain. This study has demonstrated the safety, tolerability and efficacy of pregabalin for peripheral neuropathic pain in Indian patients.     

A Comprehensive Drug Safety Evaluation of Pregabalin in Peripheral Neuropathic Pain

Pregabalin is a commonly used therapy currently recommended as first‐line treatment for a number of neuropathic pain (NeP) conditions. Since licensure, a number of clinical trials of pregabalin in different NeP conditions have been completed from which additional data on safety and tolerability can be drawn. In this analysis, patient‐level data from 31 randomized clinical trials of pregabalin in peripheral NeP sponsored by Pfizer were pooled and assessed for incidence of adverse events (AEs). Incidence by age, disease condition, and race, together with risk differences and time to onset and resolution of AEs, was assessed. In total, 7,510 patients were included: 4,884 on pregabalin (representing 805 patient‐years treatment) and 2,626 on placebo. Pregabalin vs. placebo risk analysis identified 9 AEs with a risk difference, for which the lower limit of the 95% confidence interval (CI) was > 1%: dizziness (risk difference [95% CI]: (17.0 [15.4 to 18.6]), somnolence (10.8 [9.5 to 12.1]), peripheral edema (5.4 [4.3 to 6.4]), weight increase (4.7 [3.9 to 5.5]), dry mouth (2.9 [2.1 to 3.8]), constipation (2.3 [1.5 to 3.2]), blurred vision (2.2 [1.6 to 2.9]), balance disorder (2.0 [1.5 to 2.5]), and euphoric mood (1.6 [1.2 to 2.0]). The most common AEs, dizziness and somnolence, typically emerged within the first 1 to 2 weeks of treatment and resolved 1 to 2 weeks later, without resulting in cessation of treatment. The data from this review provide information, indicating which AEs may be expected in patients treated with pregabalin, and suggest that careful dose titration to the highest tolerable dose is the most appropriate approach in clinical practice.     

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。     

Cognitive Function in Older Patients with Postherpetic Neuralgia

Background and aims

Neuropathic pain has been shown to be accompanied by cognitive impairment, but the specific impact of postherpetic neuropathic pain on cognitive processes has not been explored. This study aims to evaluate the impact of pain on several domains of cognition in older patients with postherpetic neuralgia (PHN).

Methods

This cross‐sectional study ( clinicaltrial.gov NCT 00989040) included 84 individuals after signature of informed consent. Participants: 42 patients with PHN and 42 healthy volunteers. Of the 42 PHN patients, 21 received systemic treatment (antidepressants, anticonvulsants, opiates) and 21 had topical treatment with the 5% lidocaine medicated plaster. All participants performed a panel of four cognitive tests: reaction time, semantic memory, decision‐making, and visual memory (Cantab^®, Cambridge).

Results

Forty men and 44 women with a mean age of 72 ± 8 years participated. Each PHN patient was matched by age and gender with a healthy volunteer. Vigilance, decision‐making, and semantic memory were significantly impaired (P < 0.05) in patients on systemic treatment, especially with antidepressants, while no significant changes were noted between the lidocaine plaster group and their matched controls of healthy volunteers.

Conclusion

This study shows the deleterious effect of systemic PHN treatment on several domains of cognition. Cognitive impairment associated with pain and antidepressants may be reversed by topical pain management. Topical treatment with 5% lidocaine medicated plaster is a valuable alternative for pain alleviation and maintains cognitive integrity in this vulnerable population.     

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。