Negrão Luis, Almeida Pedro, Alcino Sérgio, Duro Helena, Libório Teresa, Melo Silva Ulisses, Figueira Ricardo, Gonçalves Sílvia, Neto Parra Laura
Service of Neurology. Hospital Universitario. Ladeira da Porteladinha, No. 46, 3030-203 Coimbra, Portugal.
Pain Manag. 2014 May;4(3):191-6. doi: 10.2217/pmt.14.10. Epub 2014 May 16.
Peripheral neuropathy (PN) is a common condition whose incidence is approximately 8% in elderly persons. Neuropathic pain (NeP) has a significant incidence in the general population and affects more than half of all patients with PN. The pathophysiology of PN is characterized by lesions of myelin-producing Schwann cells in peripheral nerves. Regeneration/protection of the myelin sheath after a nerve lesion is a fundamental element of repair in PN. Nucleotides such as uridine monophosphate (UMP) have proven to be efficacious in treating the cause of the myelin sheath lesion in several experimental and clinical models. Our objective was to evaluate clinical improvement in patients with PN and NeP treated with a combination of UMP+folic acid+vitamin B12 (Keltican).
We performed an exploratory, open-label, multicenter, study of 212 patients followed for 2 months. Pain was assessed using the painDETECT questionnaire (PDQ).
The intensity of the NeP assessed at the time of the consultation progressed favorably and decreased significantly (p<0.001) in all the types of PN included. The global score for pain assessed using PDQ decreased from 17.5 points to 8.8 points at the final evaluation (p<0.001). Nonsteroidal anti-inflammatory drugs were decreased/withdrawn in 77.4% of patients.
The combination of UMP+folic acid+vitamin B12 is effective against NeP associated with PN. It leads to statistically significant reductions not only in the total PDQ score but also in the intensity of pain, number of areas affected, and pain radiation. Furthermore, it makes it possible to reduce the dosage of concomitant medication.
周围神经病变(PN)是一种常见病症,在老年人中的发病率约为8%。神经病理性疼痛(NeP)在普通人群中发病率较高,影响超过半数的PN患者。PN的病理生理学特征是周围神经中产生髓鞘的施万细胞受损。神经损伤后髓鞘的再生/保护是PN修复的基本要素。诸如单磷酸尿苷(UMP)等核苷酸已在多个实验和临床模型中被证明对治疗髓鞘损伤病因有效。我们的目的是评估接受UMP+叶酸+维生素B12联合治疗(Keltican)的PN和NeP患者的临床改善情况。
我们进行了一项探索性、开放标签、多中心研究,对212例患者进行了为期2个月的随访。使用疼痛检测问卷(PDQ)评估疼痛情况。
在会诊时评估的NeP强度呈良好进展,在所有纳入的PN类型中均显著降低(p<0.001)。使用PDQ评估的疼痛总体评分在最终评估时从17.5分降至8.8分(p<0.001)。77.4%的患者减少/停用了非甾体抗炎药。
UMP+叶酸+维生素B12联合治疗对与PN相关的NeP有效。它不仅使PDQ总分在统计学上显著降低,而且使疼痛强度、受影响区域数量和疼痛放射范围均显著降低。此外,它还能减少伴随用药的剂量。