Chau Siu-Wah, Soo Lee-Ying, Lu David Vi, Chen Tai-I, Cheng Kuang-I, Chu Koung-Shing
Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan, ROC.
Acta Anaesthesiol Taiwan. 2007 Jun;45(2):95-101.
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following acute herpes zoster infection. The main clinical problem is intractable pain which interferes with activity of daily life and reduces the quality of life in the elderly patients. This retrospective study was to evaluate the outcome of pain treatment for the elderly patients with PHN at the Pain Clinic of Kaohsiung Medical University Hospital.
Fifty-eight elderly outpatients with PHN were studied from January 2004 to June 2006. The pain intensity before and after treatment were assessed by patients themselves with numeric pain scale (NPS). The pain treatment included (1) medication with anticonvulsants, opioids and nonsteroidal anti-inflammatory drugs (NSAIDs); (2) nerve block with 0.25% bupivacaine or 1% lidocaine twice a week at the beginning of the treatment. The therapeutic outcome was expressed by pain relief. The reduction of pain and residual pain intensity were evaluated subjectively by the patients themselves with patients' global impression and NPS, respectively, after treatment for one and three months (or last visit). The adverse events throughout the treatment course were analyzed.
(1) The mean age of the patients was 75.1 yr. The number of female PHN sufferers was higher than that of male in all aged groups and the highest incidence was found in the age group of 70-79 (65.5%). The most commonly involved dermatomes were in the thoracic region (82.7%). (2) All patients suffered from severe pain (NPS 8-10) before treatment. (3) The pain management was a combination of medication and nerve block at the beginning of the treatment. Among the medications, gabapentin was prescribed to all the patients and almost all of them (98.3%) required opioids simultaneously and some of them needed additional NSAIDs at the beginning of the treatment. (4) The most common adverse event was somnolence (24.1%). (5) Among the sympathetic blocks, the intercostal nerve block was performed commonly (84.5%). (6) The therapeutic outcome was expressed by pain relief. As to the reduction of pain, 46 cases (79.3%) and 57 cases (98.3%) felt moderate and much improvement after treatment for one and three months (or last visit), respectively. As to residual pain intensity, although none of them got complete pain relief, however, there were 12 cases (20.7%) and 45 cases (77.6%) felt the pain intensity was mild (NPS 1-3) after treatment for one and three months respectively. (7) There was a statistically significant decrease in the pain intensity between before treatment and after treatment for one month and three months.
Our study results showed that the concurrent combination therapy with proper medications and appropriate nerve blocks could offer satisfactory pain relief in the majority of elderly patients with PHN.
带状疱疹后神经痛（PHN）是一种在急性带状疱疹感染后发生的神经性疼痛综合征。主要临床问题是顽固性疼痛，这会干扰日常生活活动并降低老年患者的生活质量。这项回顾性研究旨在评估高雄医学大学附属医院疼痛门诊对老年PHN患者的疼痛治疗效果。
对2004年1月至2006年6月期间的58例老年PHN门诊患者进行研究。治疗前后的疼痛强度由患者本人使用数字疼痛量表（NPS）进行评估。疼痛治疗包括：（1）使用抗惊厥药、阿片类药物和非甾体抗炎药（NSAIDs）进行药物治疗；（2）在治疗开始时每周两次使用0.25%布比卡因或1%利多卡因进行神经阻滞。治疗效果通过疼痛缓解来表示。在治疗1个月和3个月（或最后一次就诊）后，分别由患者本人使用患者整体印象和NPS主观评估疼痛减轻情况和残余疼痛强度。分析整个治疗过程中的不良事件。
（1）患者的平均年龄为75.1岁。在所有年龄组中，女性PHN患者的数量高于男性，最高发病率出现在70 - 79岁年龄组（65.5%）。最常累及的皮节位于胸部区域（82.7%）。（2）所有患者在治疗前均患有重度疼痛（NPS 8 - 10）。（3）治疗开始时，疼痛管理采用药物和神经阻滞相结合的方法。在药物中，所有患者均开具了加巴喷丁，几乎所有患者（98.3%）同时需要阿片类药物，部分患者在治疗开始时还需要额外的NSAIDs。（4）最常见的不良事件是嗜睡（24.1%）。（5）在交感神经阻滞中，肋间神经阻滞最为常用（84.5%）。（6）治疗效果通过疼痛缓解来表示。关于疼痛减轻情况，治疗1个月和3个月（或最后一次就诊）后，分别有46例（79.3%）和57例（98.3%）患者感觉有中度和明显改善。关于残余疼痛强度，尽管没有患者完全缓解疼痛，但治疗1个月和3个月后，分别有12例（20.7%）和45例（77.6%）患者感觉疼痛强度为轻度（NPS 1 - 3）。（7）治疗前与治疗1个月和3个月后的疼痛强度在统计学上有显著下降。
我们的研究结果表明，适当的药物与合适的神经阻滞联合治疗可使大多数老年PHN患者获得满意的疼痛缓解。
