水冷射频治疗头面部难治性带状疱疹后神经痛

目的:评估水冷射频治疗头面部难治性带状疱疹后神经痛的临床可行性.方法:对11例头面部难治性带状疱疹后神经痛、经传统射频治疗后效果欠佳患者行水冷射频治疗,记录治疗前及治疗后1天、7天、14天、1个月和6个月时疼痛数字评分(NRS)及并发症发生情况.结果:患者治疗后NRS显著下降(P＜0.01),术后出现治疗局部软组织肿胀,1～2周内缓解.结论:水冷射频治疗头面部难治性带状疱疹后神经痛效果确切、安全.     

CT引导下单次脉冲射频治疗头面部带状疱疹后神经痛的疗效分析

目的:观察和分析CT引导下选择性三叉神经单次脉冲射频治疗头面部带状疱疹后神经痛(pos-therpetic neuralgia, PHN)的临床效果。方法:36例头面部PHN住院病人随机分为2组:神经阻滞治疗组(A组);脉冲射频治疗组(B组)。A组在给予加巴喷丁治疗的基础上,根据受累三叉神经分支相应实施眶上、上颌、下颌神经及局部痛域皮下阻滞治疗;B组在给予加巴喷丁治疗的基础上,根据受累三叉神经分支相应实施CT引导下眶上神经、上颌神经和下颌神经脉冲射频治疗。治疗前及疗程完成后第3天、3月和12月进行疼痛程度评估。结果:各组疗程完成后第3天视觉模拟评分法(visual analogue scale, VAS)评分均较治疗前减低(P <0.05)。疗程完成后3月和12月各组治疗显效率均达60%以上,A组和B组显效率比较无统计学差异(P> 0.05)。各例治疗过程中均无严重并发症发生。结论:CT引导下选择性三叉神经单次脉冲射频是治疗头面部PHN安全而有效的方法,但临床效果不优于神经阻滞治疗。     

脉冲射频技术治疗带状疱疹后神经痛的研究进展

脉冲射频技术治疗带状疱疹后神经痛具有安全有效、微创等优点。随着该技术在临床应用越来越广泛,对其镇痛机制及参数设定的研究也逐渐深入。同时存在如何选择治疗时机、选用何种方法进行穿刺定位、射频参数描述不规范、如何更好利用该技术等问题。本文就目前脉冲射频技术治疗带状疱疹后神经痛的研究现状及新进展做一综述。     

头面部带状疱疹后遗神经痛的临床治疗观察

目的本研究的目的在于探讨两种治疗方法联合应用的临床价值,效果评定以及推广应用的前景。方法本研究选择了60例患者,第一组为治疗组30例,行星状神经节阻滞加服加巴喷丁。第二组30例为对照组应用星状神经节阻滞伍用非甾体消炎止痛药。结果显示治疗组VAS评分低于对照组且不良反应减少。结论星状神经节阻滞伍用加巴喷丁治疗头面部带状疱疹后遗神经痛是一种比较有效的治疗方法,值得推广应用。     

射频热凝治疗带状疱疹后神经痛研究分析

带状疱疹后神经痛是可发于各年龄层群体,以老年人最为多见的带状疱疹后遗症,其对患者日常作息与行动都构成了严重影响。目前,带状疱疹后神经痛治疗方式多样。射频热凝技术得到了临床一致认可。本文总结了近三年以来射频热凝治疗带状疱疹后神经痛的研究成果,以期指导临床选用最为合理的医治手段。     

背根神经节射频治疗不同病程阶段带状疱疹后神经痛的疗效研究

目的 分析背根神经节射频治疗不同病程阶段带状疱疹后神经痛的临床效果.方法 选取2020年5月至2021年6月绵阳市中心医院收治的带状疱疹后神经痛患者114例作为研究对象,采用随机数字表法分为对照组与观察组,各57例.对照组采用药物干预,观察组采用背根神经节射频治疗进行干预,统计患者不同病程的疼痛评分情况、睡眠质量情况、...     

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。     

射频毁损术治疗带状疱疹后遗神经痛患者的术中配合及护理

目的探讨射频毁损术治疗带状疱疹后遗神经痛的术中配合及护理。方法选择48例带状疱疹后神经痛患者,根据带状疱疹神经受损部位不同,分别对不同受损部位的神经支行射频毁损术治疗,并采取积极的术前护理、术中配合、术后护理等护理措施。结果患者术后恢复良好,疼痛缓解有效率为95.8%。结论射频毁损术治疗带状疱疹后遗神经痛疗效确切,围术期切实有效的护理和术中良好的医护配合是保证手术成功的关键。     

PCEA治疗带状疱疹后神经痛的护理体会

我们对14例带状疱疹后神经痛(PHN)的病人行硬膜外自控镇痛(PCEA)治疗期间进行观察和护理。经过我们对病人的心理、硬膜外阻滞、镇痛泵以及吗啡副作用的观察和护理，14例病人中无一例出现严重的并发症，治疗取得良好的效果，有效率达100％，其中有12例治愈。提示：PHN行PCEA治疗期间，良好的护理是治疗成功的保证。     

Lumbar Sympathetic Block for Intractable Lower-Limb Postherpetic Neuralgia: Report of Two Cases

Lumbar sympathetic block is a commonly used technique for sympathetically mediated pain syndromes. Postherpetic neuralgia (PHN) is also accepted to be associated with sympathetic system activation. While sympathetic blocks were utilized for upper-extremity or face-related PHN, there has not been any report regarding lower-extremity PHN, as it is an uncommon region. Here, we present two cases of systemic drug-resistant PHN in lower limb, relieved with lumbar sympathetic block. Both patients had at least 50% reduction in numeric rating scale (NRS) scores at the end of 6 months. Lumbar sympathetic block could be considered in the treatment of lower-limb PHN. More reports and controlled trials are needed for further understanding the role of the intervention in this neuropathic pain syndrome.     

Postherpetic Neuralgia

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. This article is about postherpetic neuralgia (PHN), a devastating complication following reactivation of the varicella-zoster virus. The answer offers an explanation for why this pain occurs, and cites literature regarding its incidence and treatment.     

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.     

射频治疗三叉神经痛高龄患者的日间手术护理

目的探讨日间手术护理应用于螺旋CT引导下射频热凝治疗高龄重症三叉神经痛患者的模式。方法42例患者分成两组,每组各21例。A组患者年龄为40～60岁,采用常规日间手术护理,B组患者年龄80～92岁。充分评估日间手术风险,制定并实施针对性护理措施,重视术前心理护理,加强术中监测。比较两组患者手术前、后组间及组内的视觉模拟评分(VAS),以及并发症。结果手术前及术后2周,两组VAS评分无显著性差异(P>0.05);与术前比较,两组术后2周VAS评分明显低于术前(P<0.01)。两组患者均无严重手术相关并发症。结论日间手术护理模式应用于高龄重症三叉神经射频热凝术患者是安全的、适用的。     

Postherpetic Neuralgia

ABSTRACT

Questions from patients about analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. The topic addressed in this issue is postherpetic neuralgia, symptoms, risk factors, and treatment.     

Therapeutic Options for the Treatment of Postherpetic Neuralgia: A Systematic Review

ABSTRACT

Postherpetic neuralgia (PHN) is a chronic and painful condition that may result in significant disturbances to normal activities and decreases in the quality of life for those affected. Despite the availability of several first- and second-line treatment options, many patients may experience refractory pain. The objectives of this review were to summarize evidence for Food and Drug Administration (FDA)-approved and off-label therapies for the treatment of PHN and to present gaps in the current literature for future research focus. Several agents, including pregabalin, gabapentin, and opioids, have been shown to significantly improve pain when compared with placebo. However, evidence regarding the comparative effectiveness of these treatment alternatives is lacking. In order to choose the optimal treatment, providers should consider issues related to efficacy, safety, and tolerability in conjunction with patient goals, preferences, and adherence issues. Evidence from randomized or observational studies that directly compare agents with each other should help to inform treatment choices.