Moriyama Michiru, Kitamura Akira, Ikezaki Hiroyuki, Nakanishi Kazuhiro, Kim Choru, Sakamoto Atsuhiro, Ogawa Ryo
Department of Anesthesia, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8603 Tokyo, Japan.
J Anesth. 2004;18(3):177-80. doi: 10.1007/s00540-004-0240-x.
Activation of purinoceptors may improve neuropathic pain. Accordingly, the effects of systemic ATP infusion were assessed in patients with postherpetic neuralgia (PHN).
Eight patients with PHN lasting over 3 months were enrolled. Initially, patients received the vehicle (20% dextrose) or ATP (at a dose of 1 mg x kg(-1) in 20% dextrose) infused intravenously for 60 min on two separate occasions in a single-blinded manner. The levels of spontaneous continuous pain, paroxysmal pain, and tactile allodynia were assessed by a visual analogue scale (VAS), and tactile hypesthesia was assessed by Semmes-Weinstein monofilament before and after infusion. Subsequently, the eight patients received an ATP infusion (1 mg.kg(-1) in 20% dextrose) once a week for 5-12 weeks in an open-label manner, and changes in the above parameters were assessed.
In the initial study, VAS for spontaneous continuous pain and tactile allodynia decreased significantly with ATP infusion but not with placebo infusion. After repeated ATP infusions for 5-12 weeks, the median VAS for spontaneous continuous pain, paroxysmal pain, and tactile allodynia decreased significantly from 32.1 to 13.0, from 46.9 to 17.5, and from 49.5 to 15.6 respectively. However tactile hypesthesia did not improve significantly.
This study demonstrated that repetitive intravenous ATP infusion could improve spontaneous continuous pain and paroxysmal pain, as well as improving tactile allodynia, but did not influence tactile hypesthesia.
嘌呤受体的激活可能会改善神经性疼痛。因此,我们评估了全身性ATP输注对带状疱疹后神经痛(PHN)患者的影响。
招募了8名患有持续超过3个月的PHN患者。最初,患者在两个不同的场合以单盲方式接受静脉输注溶媒(20%葡萄糖)或ATP(以1mg·kg⁻¹的剂量溶于20%葡萄糖中)60分钟。在输注前后,通过视觉模拟量表(VAS)评估自发持续性疼痛、阵发性疼痛和触觉性痛觉过敏的程度,通过Semmes-Weinstein单丝评估触觉减退。随后,8名患者以开放标签的方式每周接受一次ATP输注(1mg·kg⁻¹溶于20%葡萄糖中),持续5 - 12周,并评估上述参数的变化。
在初始研究中,ATP输注后自发持续性疼痛和触觉性痛觉过敏的VAS显著降低,而安慰剂输注则无此效果。在重复ATP输注5 - 12周后,自发持续性疼痛、阵发性疼痛和触觉性痛觉过敏的VAS中位数分别从32.1显著降至13.0、从46.9显著降至17.5、从49.5显著降至15.6。然而,触觉减退并未显著改善。
本研究表明,重复静脉输注ATP可改善自发持续性疼痛和阵发性疼痛,以及改善触觉性痛觉过敏,但不影响触觉减退。