目的 综合评价利多卡因乳膏作为发散式体外冲击波介质治疗带状疱疹后神经痛的临床可行性及有效性。方法 选择非头面部带状疱疹后神经痛患者90例,随机分为试验组和对照组,每组45例。试验组为利多卡因乳膏介导组,对照组为超声耦合剂介导组。治疗期间所有患者给予药物、发散式体外冲击波治疗、背根神经节射频调节术和神经阻滞术。此外,试验组采用利多卡因乳膏为发散式体外冲击波治疗的介质;对照组采用超声耦合剂为发散式体外冲击波治疗的介质。采用视觉模拟评分、触诱发痛治疗有效率和汉密尔顿抑郁量表,比较两组治疗前,治疗结束后即刻、2周、4周、8周和12周疼痛程度、触诱发痛情况和情绪情况;比较两组试验期间阿片类药物和普瑞巴林用量,并记录患者不良反应。结果 疼痛程度评分比较:在治疗后即刻和2周时,试验组视觉模拟评分(VAS)分别为1.96±0.77和2.25±0.89;对照组VAS分别为2.97±0.79和3.40±0.81。与对照组比较,试验组VAS较低(P<0.05)。在治疗后4周、8周、12周时,试验组VAS分别为8.04±2.90、2.82±0.65和2.64±0.91;对照组VAS分别为2.87±0.61、3.07±0.72和2.98±0.72。两组VAS比较差异无统计学意义。阿片类药物和普瑞巴林用量比较:与对照组相比,试验组羟考酮和普瑞巴林用量较少。两组均未发现发散式体外冲击波治疗相关并发症。结论 利多卡因乳膏作为发散式体外冲击波的介质,在治疗带状疱疹后神经痛时,可以降低疼痛程度,提高触诱发痛缓解率,减少普瑞巴林和阿片类药物用量,是一种安全、有效的治疗方式。
Abstract
Objective To evaluate the clinical feasibility and efficacy of lidocaine cream being used as a divergent extracorporeal shock wave therapy(ESWT) for postherpetic neuralgia. Methods Ninety patients with non-head and face postherpetic neuralgia were randomly divided into two groups using the block randomization method.The treatment group(n=45) received lidocaine cream-mediated ESWT while the control group(n=45) was treated with ultrasonic couplant-mediated ESWT.Both groups received medication,ESWT,pulsed radiofrequency and nerve block. The Visual Analogue Scale(VAS),hyperalgesia,Hamilton Depression Scale(HAMD),doses of opioids and pregabalin and adverse reactions were observed in both groups for 12 weeks. Results Pain score comparison: Immediately after treatment and 2 weeks after treatment, the Visual Analogue Scale (VAS) of the treatment group was 1.96±0.77 and 2.25±0.89 respectively, compared with 2.97±0.79 and 3.40±0.81 in the control group. The doses of oxycodone and pregabalin were lower in the treatment group than in the control group.There were no complications related to ESWT in either group. Conclusions Our data suggests that lidocaine cream-mediated ESWT is effective and safe for PHN patients, which can be used as a supplementary treatment of PHN in grassroots hospitals.
关键词
带状疱疹后遗神经痛 /
发散式 /
体外冲击波治疗 /
利多卡因乳膏
Key words
postherpetic neuralgia /
divergent /
extracorporeal shock wave therapy /
lidocaine cream
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参考文献
[1] Werner R N, Nikkels A F, Marinovic B, et al. European consensus-based (S2k) guideline on the management of herpes zoster-guided by the european dermatology forum (EDF) in cooperation with the european academy of dermatology and venereology (EADV), Part 1: Diagnosis[J]. J Eur Acad Dermatol Venereol, 2017, 31(1):9-19.
[2] Yang F, Yu S, Fan B, et al. The epidemiology of herpes zoster and postherpetic neuralgia in China: results from a cross-sectional study[J]. Pain Ther, 2019, 8(2):249-259.
[3] Lin C S, Lin Y C, Lao H C, et al. Interventional treatments for postherpetic neuralgia: a systematic review[J]. Pain Physician, 2019, 22(3):209-228.
[4] Walewicz K, Taradaj J. The effectiveness of radial extracorporeal shock wave therapy in patients with chronic low back pain: a prospective, randomized, single-blinded pilot study[J]. Clin Interv Aging, 2019, 14:1859-1869.
[5] De Lima Morais T M, Meyer P F, De Vasconcellos L S, et al. Effects of the extracorporeal shock wave therapy on the skin: an experimental study[J]. Lasers Med Sci, 2019, 34(2):389-396.
[6] 刘水涛, 杨 军, 史 展, 等. 发散式体外冲击波治疗距骨骨软骨损伤的效果[J]. 武警医学, 2017, 28(7):694-697.
[7] 刘 彧, 吴 坤, 刘水涛, 等. 体外冲击波治疗中老年女性膝关节炎的疗效观察[J]. 武警医学, 2016, 27(4):349-352.
[8] 田俊斌, 罗 斌, 赵 静, 等. 不同频率分散式体外冲击波治疗带状疱疹后神经痛的临床疗效[J]. 西部医学, 2019, 31(10):1605-1608.
[9] 张 芹, 杨科朋, 魏新侠, 等. 神经妥乐平联合体外冲击波疗法治疗带状疱疹后神经痛的临床疗效[J]. 北方药学, 2018, 15(7):125-126.
[10] 刘晓华, 郑拥军, 徐伟豪, 等. 体外发散式冲击波治疗带状疱疹后遗神经痛短期疗效观察[J]. 中国现代神经疾病杂志, 2013, 13(10):868-871.
[11] Hausner T, Nogradi A. The use of shock waves in peripheral nerve regeneration: new perspectives?[J]. Int Rev Neurobiol, 2013, 109:85-98.
[12] Derry S, Wiffen P J, Moore R A, et al. Topical lidocaine for neuropathic pain in adults[J]. Cochrane Database Syst Rev, 2014, 7: 10958.
[13] Casale R, Mattia C. Building a diagnostic algorithm on localized neuropathic pain (LNP) and targeted topical treatment: focus on 5% lidocaine-medicated plaster[J]. Ther Clin Risk Manag, 2014, 10:259-268.
[14] Baron R,Allegri M,lanes G, et al.The 5% lidocaine-medicated plaster: its inclusion in international treatment guidelines for treating localized neuropathic pain, and clinical evidence supporting its Use[J]. Pain Ther, 2016, 5(2):149-169.
[15] Clere F, Delorme M C, George B, et al. 5% lidocaine medicated plaster in elderly patients with postherpetic neuralgia: results of a compassionate use programme in France[J]. Drugs Aging, 2011, 28(9):693-702.
[16] Lopez L M, Rivera A L, Fernandez F, et al. Shock wave-induced permeabilization of mammalian cells[J]. Phys Life Rev, 2018, 26-27:1-38.
[17] Luh J J, Huang W T, Lin K H, et al. Effects of extracorporeal shock wave-mediated transdermal local anesthetic drug delivery on rat caudal nerves[J]. Ultrasound Med Biol, 2018, 44(1):214-222.
[18] 于生元, 万 有, 万 琪, 等. 带状疱疹后神经痛诊疗中国专家共识[J]. 中国疼痛医学杂志, 2016, 22(3):161-167.
[19] Johnson R W, Wasner G, Saddier P, et al. Postherpetic neuralgia: epidemiology, pathophysiology and management[J]. Expert Rev Neurother, 2007, 7(11):1581-1595.
[20] Truini A, Garcia L, Cruccu G. Reappraising neuropathic pain in humans--how symptoms help disclose mechanisms[J]. Nat Rev Neurol, 2013, 9(10):572-582.
[21] Wasner G, Kleinert A, Binder A, et al. Postherpetic neuralgia: topical lidocaine is effective in nociceptor-deprived skin[J]. J Neurol, 2005, 252(6):677-686.
[22] Corallo F, Salvo S, Floridia D, et al. Assessment of spinal cord stimulation and radiofrequency: chronic pain and psychological impact[J]. Medicine (Baltimore), 2020, 99(3):e18633.
[23] Kasper S, Brasser M, Schweizer E, et al. How well do randomized controlled trial data generalize to 'real-world' clinical practice settings? A comparison of two generalized anxiety disorder studies[J]. Eur Neuropsychopharmacol, 2014, 24(1):125-132.
[24] Onakpoya I J, Lee J J, Thomas E T, et al. Benefits and harms of pregabalin in the management of neuropathic pain: a rapid review and meta-analysis of randomised clinical trials[J]. BMJ Open, 2019, 9(1):e023600.
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