Department of Anaesthetics, Surgical, and Emergency Sciences, Second University of Naples, Italy.
Clin J Pain. 2010 Sep;26(7):567-72. doi: 10.1097/AJP.0b013e3181dda1ac.
Postherpetic neuralgia (PHN) is responsible for one of the most common types of neuropathic pain, described as a burning pain that shakes, hits, and tightens and includes allodynia and paresthesia.
To evaluate the efficacy of Pregabalin when used during transcutaneous electric nerve stimulation (TENS) in patients with PHN and to analyze any changes in physical activity and sleep quality.
Patients aged 50 to 80 years were included in this randomized study. We enrolled 15 male (average age 65+/-8.6 y) and 15 female patients (average age 64+/-8.2 y). The male patients had a history of neuropathic pain lasting 15.6+/-8.8 months whereas the female patients had a history of neuropathic pain lasting about 14.9+/-8.6 months. We began with 1 week of patient screening followed by a week of Pregabalin titration. Then, we established the dose of Pregabalin for each patient to obtain visual analog scale (VAS) of less than 60 mm. The eligible patients were randomly divided into 2 groups receiving Pregabalin + TENS or Pregabalin+TENS placebo for the following 4 weeks. Patients underwent 8 outpatient visits during which they completed VAS, SF-McGill Pain Questionnaire, and sleep interference questionnaire.
The resulting data showed that Pregabalin administration associated with TENS reduced pain in patients with PHN. At the end of the treatment, all the observed groups presented a reduction of mean VAS. The group treated with Pregabalin 300 (P300)+TENS had a reduction of pain of 30% and the group treated with Pregabalin 600 (P600)+TENS had a reduction of pain of 40%. The comparison between group P300+TENS versus group P300+TENS placebo showed a statistically significant reduction of VAS (P300+TENS 25+/-0.67 vs. P300+TENS placebo 39+/-1.19 P<0.02). Moreover, the comparison between group P600+TENS versus group P600+TENS placebo has shown a statistically significant reduction of VAS (P600+TENS 23+/-0.78 vs. P600+TENS placebo 32+/-0.81 P<0.02). At the end of the study, all groups showed a statistically significant difference in terms of sleep interference, Short-Form McGill Pain Questionnaire total score, and Short-Form McGill Pain Questionnaire Present Pain Intensity.
These data support the conclusion that Pregabalin gives better results when combined with TENS therapy, which is an analgesic nonpharmacologic procedure. Therefore, a multidisciplinary treatment should be considered for this kind of pain.
带状疱疹后神经痛（PHN）是最常见的神经病理性疼痛类型之一，其特征为灼痛、震颤、紧束感，并伴有感觉过敏和感觉异常。
评估普瑞巴林联合经皮神经电刺激（TENS）治疗 PHN 的疗效，并分析其对患者躯体活动和睡眠质量的影响。
本研究为随机对照研究，纳入 50-80 岁患者，共 30 例，男 15 例（平均年龄 65±8.6 岁），女 15 例（平均年龄 64±8.2 岁）。男性患者的神经病理性疼痛病史为 15.6±8.8 个月，女性患者为 14.9±8.6 个月。患者首先进行 1 周的筛选期，随后进行 1 周的普瑞巴林滴定期。根据视觉模拟评分（VAS）确定每位患者的普瑞巴林剂量，使 VAS 评分<60mm。合格患者被随机分为两组，分别接受普瑞巴林+TENS 和普瑞巴林+TENS 安慰剂治疗 4 周。患者共进行 8 次门诊随访，记录 VAS、SF-McGill 疼痛问卷和睡眠干扰问卷。
普瑞巴林联合 TENS 治疗可显著减轻 PHN 患者的疼痛。治疗结束时，所有观察指标均显示 VAS 评分降低。普瑞巴林 300mg（P300）+TENS 组疼痛缓解率为 30%，普瑞巴林 600mg（P600）+TENS 组疼痛缓解率为 40%。与 P300+TENS 安慰剂组相比，P300+TENS 组 VAS 评分显著降低（P300+TENS 25±0.67 比 P300+TENS 安慰剂 39±1.19，P<0.02）。此外，P600+TENS 组与 P600+TENS 安慰剂组 VAS 评分也有显著差异（P600+TENS 23±0.78 比 P600+TENS 安慰剂 32±0.81，P<0.02）。研究结束时，所有组的睡眠干扰、SF-McGill 疼痛问卷总分和当前疼痛强度评分均有显著差异。
这些数据支持普瑞巴林联合 TENS 治疗的结论，这是一种有效的非药物镇痛方法。因此，对于这种疼痛，应考虑多学科治疗。
