Kleijnen Systematic Reviews Ltd, York, UK.
Acta Neurol Scand. 2011 May;123(5):295-309. doi: 10.1111/j.1600-0404.2010.01433.x. Epub 2010 Oct 10.
Several pharmacological treatments are used to manage post-herpetic neuralgia (PHN). The use of topical analgesics, such as 5% lidocaine-medicated plaster (5% LMP), may be preferable to systemic treatments in that they are formulated to produce a local pain relieving effect with minimal systemic absorption. However, direct head-to-head comparisons are relatively few, and a rigorous assessment of the relative efficacy and safety of the various treatment options is lacking. The objective of this study was to compare 5% LMP for the relief of PHN with other relevant interventions and placebo. Six databases were searched up to May 2010. Quantitative methods for data synthesis were used, and a network meta-analysis was conducted. Twenty unique studies (32 publications) were included. Placebo-controlled studies showed 5% LMP to be effective in providing pain relief and reducing allodynia while adverse event rates were generally low. A comparison between 5% LMP and pregabalin indicated the non-inferiority of 5% LMP for pain reduction and showed greater improvement of quality of life for 5% LMP. Adverse events (AE) were significantly fewer with 5% LMP. In the network meta-analysis, only 5% LMP and gabapentin were associated with a greater change in pain from baseline than placebo [-15.50 (95% CI -18.85 to -12.16) and -7.56 (95% CI -12.52 to -2.59) respectively]. 5% LMP was shown to be more effective than capsaicin [-16.45 (95% CI -20.04 to -12.86)], gabapentin [-7.95 (95% CI -13.29 to -2.61)] and pregabalin [-13.45 (95% CI -19.19 to -7.71)]. For pain relief, two comparators were more effective than placebo [mean pain relief, gabapentin: 32.77 (95% CI 15.57-49.97); 5% LMP: 26.77 (95% CI 9.11-44.43)]. 5% LMP was shown to be comparable to gabapentin [-6.00 (95% CI -25.32-13.32)]. The results suggest that 5% LMP and gabapentin have similar effects on pain relief and that 5% LMP is more effective than capsaicin and pregabalin (change in pain from baseline). Topical agents, such as 5% LMP, are associated with fewer and less clinically significant AE than is the case for systemic agents. However, small numbers, and limited size and quality of included studies should be taken into account. Further studies are needed.
几种药理学治疗方法被用于治疗疱疹后神经痛 (PHN)。与全身治疗相比，局部使用止痛剂，如 5%利多卡因贴剂（5% LMP），可能更可取，因为它们的配方旨在产生局部止痛效果，同时最小化全身吸收。然而，直接的头对头比较相对较少，并且缺乏对各种治疗选择的相对疗效和安全性的严格评估。本研究的目的是比较 5% LMP 与其他相关干预措施和安慰剂对 PHN 的缓解作用。六个数据库被搜索到 2010 年 5 月。使用了数据综合的定量方法，并进行了网络荟萃分析。纳入了 20 项独特的研究（32 篇文献）。安慰剂对照研究表明，5% LMP 可有效缓解疼痛并减轻痛觉过敏，而不良事件发生率通常较低。5% LMP 与普瑞巴林的比较表明，5% LMP 在减轻疼痛方面不劣于普瑞巴林，并显示出 5% LMP 对生活质量的改善更大。5% LMP 的不良事件明显较少。在网络荟萃分析中，只有 5% LMP 和加巴喷丁与安慰剂相比，疼痛从基线的变化更大[-15.50（95%CI-18.85 至-12.16）和-7.56（95%CI-12.52 至-2.59）]。5% LMP 被证明比辣椒素[-16.45（95%CI-20.04 至-12.86）]、加巴喷丁[-7.95（95%CI-13.29 至-2.61）]和普瑞巴林[-13.45（95%CI-19.19 至-7.71）]更有效。对于缓解疼痛，两种对照药物比安慰剂更有效[平均疼痛缓解，加巴喷丁：32.77（95%CI 15.57-49.97）；5% LMP：26.77（95%CI 9.11-44.43）]。5% LMP 与加巴喷丁相当[-6.00（95%CI-25.32-13.32）]。结果表明，5% LMP 和加巴喷丁在缓解疼痛方面有相似的效果，5% LMP 比辣椒素和普瑞巴林更有效（疼痛从基线的变化）。局部制剂，如 5% LMP，与全身制剂相比，不良事件更少且不那么具有临床意义。然而，应考虑到纳入研究的数量较少、规模较小和质量较低。需要进一步的研究。
