Levin O S, Moseĭkin I A
Zh Nevrol Psikhiatr Im S S Korsakova. 2009;109(12):60-5.
Optimal conservative therapy of discogenic lumbosacral radiculopathy is a matter of debates. Contemporary guidelines recommend measures that predominantly have an influence on nociceptive mechanisms. However the mixed nature of pain in patients with discogenic radiculopathy requires approaches used for treatment of neuropathic pain. We carried out an open pilot study on efficacy of the anticonvulsant gabapentin in 25 patients with discogenic lumbosacral radiculopathy who were divided into two groups (with duration of pain episode 1 month or less and more than 1 month). Gabapentin was used in increasing doses up to 3600 mg/day. To the end of 8-week trial, the significant reduction of pain and restricted mobility was found. The reduction of symptoms was more rapid in the group with earlier onset of treatment. In both groups, the reduction of vertebral syndrome and neuropathic pain characteristics was noticed as well. The clinically significant effect was found in 59% of patients with early onset of treatment with gabapentin and in 51% of patients with later onset. These results suggest that early use of gabapentin (tebantin) holds promises for treatment of discogenic radiculopathy.
椎间盘源性腰骶神经根病的最佳保守治疗方法存在争议。当代指南推荐的措施主要影响伤害性感受机制。然而,椎间盘源性神经根病患者疼痛的混合性质需要采用治疗神经性疼痛的方法。我们对25例椎间盘源性腰骶神经根病患者进行了一项关于抗惊厥药物加巴喷丁疗效的开放性试验研究,这些患者被分为两组(疼痛发作持续时间为1个月或更短以及超过1个月)。加巴喷丁的剂量逐渐增加至每日3600毫克。到8周试验结束时,发现疼痛和活动受限有显著减轻。治疗开始较早的组症状减轻更快。在两组中,还注意到脊柱综合征和神经性疼痛特征有所减轻。在加巴喷丁治疗开始较早的患者中,59%有临床显著疗效,在治疗开始较晚的患者中,51%有临床显著疗效。这些结果表明,早期使用加巴喷丁(痛痉宁)有望治疗椎间盘源性神经根病。