口服加巴喷丁类药物和神经阻滞治疗慢性眼部疼痛。

Oral Gabapentinoids and Nerve Blocks for the Treatment of Chronic Ocular Pain.

机构信息

Department of Ophthalmology (L.R.S., A.G., E.R.F., R.C.L., C.D.S.), Bascom Palmer Eye Institute, University of Miami, Miami, FL; Ophthalmology, Miami Veterans Administration Medical Center (A.G.), Miami, FL; Physical Medicine and Rehabilitation (E.R.F.), University of Miami, Miami, FL; Department of Anesthesiology, Perioperative Medicine and Pain Management (D.B.H., R.C.L., C.D.S.), University of Miami Miller School of Medicine, Miami, FL; John P. Hussman Institute for Human Genomics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; and John T Macdonald Foundation Department of Human Genetics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL.

出版信息

Eye Contact Lens. 2020 May;46(3):174-181. doi: 10.1097/ICL.0000000000000630.

DOI:10.1097/ICL.0000000000000630

PMID:31206369

Abstract

PURPOSE

There is a recognition that nerve dysfunction can contribute to chronic ocular pain in some individuals. However, limited data are available on how to treat individuals with a presumed neuropathic component to their ocular pain. As such, the purpose of this study was to examine the efficacy of our treatment approaches to this entity.

METHODS

A retrospective review of treatments and outcomes in individuals with chronic ocular pain that failed traditional therapies.

RESULTS

We started eight patients on an oral gabapentinoid (gabapentin and/or pregabalin) as part of their pain regimen (mean age 46 years, 50% women). Two individuals reported complete ocular pain relief with a gabapentinoid, in conjunction with their topical and oral medication regimen. Three individuals noted significant improvements, one slight improvement, and two others no improvement in ocular pain with gabapentin or pregabalin. We performed periocular nerve blocks (4 mL of 0.5% bupivacaine mixed with 1 mL of 80 mg/mL methylprednisolone acetate) targeting the periocular nerves (supraorbital, supratrochlear, infratrochlear, and infraorbital) in 11 individuals (mean age 54 years, 36% women), 10 of whom had previously used a gabapentinoid without ocular pain improvement. Seven individuals experienced pain relief after nerve blocks that lasted from hours to months and four failed to benefit. Five of the individuals who experienced pain relief underwent repeat nerve blocks, weeks to months later.

CONCLUSIONS

Approaches used to treat chronic pain outside the eye can be applied to ocular pain that is not responsive to traditional therapies.

摘要

目的

人们认识到神经功能障碍可能导致某些个体出现慢性眼部疼痛。然而，关于如何治疗眼部疼痛中推测存在神经病理性成分的个体，目前数据有限。因此，本研究旨在评估我们针对此类疾病的治疗方法的疗效。

方法

对传统疗法治疗失败的慢性眼部疼痛患者的治疗方法和结果进行回顾性分析。

结果

我们开始让 8 名患者（平均年龄 46 岁，女性占 50%）口服加巴喷丁类药物（加巴喷丁和/或普瑞巴林）作为其疼痛治疗方案的一部分。有 2 名患者报告称，在联合使用局部和口服药物的情况下，加巴喷丁类药物完全缓解了眼部疼痛。有 3 名患者表示眼部疼痛显著改善，1 名患者略有改善，另外 2 名患者使用加巴喷丁或普瑞巴林后眼部疼痛无改善。我们对 11 名患者（平均年龄 54 岁，女性占 36%）行眶周神经阻滞（4 mL 0.5%布比卡因混合 1 mL 80mg/mL 甲泼尼龙醋酸酯），以阻滞眶周神经（眶上、滑车上、眶下和眼下神经），其中 10 名患者之前使用过加巴喷丁类药物但眼部疼痛无改善。7 名患者在神经阻滞后疼痛缓解，缓解时间从数小时到数月不等，4 名患者未获益。在经历疼痛缓解的 5 名患者中，有 3 名在数周至数月后再次接受了神经阻滞。