Rehm Stefanie, Groβkopf Moritz, Kabelitz Maria, Keller Thomas, Freynhagen Rainer, Tölle Thomas R, Baron Ralf
Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
StatConsult GmbH, Magdeburg, Germany.
Pain Rep. 2018 Feb 6;3(1):e636. doi: 10.1097/PR9.0000000000000636. eCollection 2018 Jan.
Animal experimental evidence suggests that mechanisms of pain generation and response to treatment differ between neuropathic pain in the cephalic and the extracephalic innervation territories.
The objective of the study was to examine whether in humans an identical peripheral painful neuropathy is associated with different pain qualities and sensory abnormalities in the face as compared with the thoracic region.
We retrospectively analysed epidemiological and clinical data of 639 patients with postherpetic neuralgia (PHN) in the face and at the trunk who were collected within a cross-sectional cohort survey and compared the respective sensory symptom profiles captured with the painDETECT questionnaire.
Two hundred twenty-four patients suffered from trigeminal PHN and 415 from thoracolumbar PHN. There were no significant differences in sex-ratio, age, body mass index, and pain duration. Patients with trigeminal PHN were more often severely depressed. Anxiety and sleep scores were not different. The average pain intensity was slightly higher in thoracolumbar PHN than trigeminal PHN (visual analogue scale 5.0 vs 4.6). Postherpetic neuralgia in the thoracolumbar region showed significantly more intense burning sensations, allodynia, painful attacks, and significantly less prickling and numbness than PHN in the face.
The differences in sensory symptom profiles between facial PHN and truncal PHN might be associated with different pathophysiological mechanisms and different treatment response. Drugs that primarily act on sensitization processes in the peripheral nociceptive system may work better in thoracolumbar PHN than in trigeminal PHN. If new medications are tested in patients with PHN, it would therefore be of interest to include an analysis of the treatment results in regard to subgroups based on the localisation of pain in patients with PHN.
动物实验证据表明，头面部和头面部以外神经支配区域的神经性疼痛在疼痛产生机制和对治疗的反应方面存在差异。
本研究的目的是检验在人类中，相同的周围性疼痛性神经病变与面部相比，在胸部区域是否具有不同的疼痛性质和感觉异常。
我们回顾性分析了在一项横断面队列研究中收集的639例面部和躯干带状疱疹后神经痛（PHN）患者的流行病学和临床数据，并比较了用疼痛DETECT问卷获取的各自感觉症状概况。
224例患者患有三叉神经PHN，415例患有胸腰段PHN。在性别比例、年龄、体重指数和疼痛持续时间方面没有显著差异。三叉神经PHN患者更常出现严重抑郁。焦虑和睡眠评分没有差异。胸腰段PHN的平均疼痛强度略高于三叉神经PHN（视觉模拟量表分别为5.0和4.6）。与面部PHN相比，胸腰段带状疱疹后神经痛表现出更强烈的烧灼感、痛觉过敏、疼痛发作，且刺痛和麻木明显更少。
面部PHN和躯干PHN之间感觉症状概况的差异可能与不同的病理生理机制和不同的治疗反应有关。主要作用于周围伤害性感受系统敏化过程的药物在胸腰段PHN中可能比在三叉神经PHN中效果更好。因此，如果在PHN患者中测试新药物，根据PHN患者疼痛部位对亚组治疗结果进行分析将是有意义的。
