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CT引导下脉冲射频治疗三叉神经带状疱疹后神经痛的疗效

Efficacy of CT Guided Pulsed Radiofrequency Treatment for Trigeminal Postherpetic Neuralgia.

作者信息

Ding Yuanyuan, Hong Tao, Li Hongxi, Yao Peng, Zhao Guangyi

机构信息

Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China.

Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.

出版信息

Front Neurosci. 2019 Jul 9;13:708. doi: 10.3389/fnins.2019.00708. eCollection 2019.


DOI:10.3389/fnins.2019.00708
PMID:31354417
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6630731/
Abstract

OBJECTIVES: Trigeminal postherpetic neuralgia (TPHN) often presents with moderate to severe pain, hyperalgesia, and allodynia. Conventional analgesic treatments are poorly effective, which seriously affects the quality of life. This retrospective study aimed to evaluate the efficacy of pulsed radiofrequency (PRF) for the treatment of TPHN. METHODS: A total of 90 TPHN patients were selected between January 2014 and December 2016 in the Department of Pain Management, Shengjing Hospital, China Medical University. Patients were randomly divided into two groups according to the order of enrollment ( = 45 per group): group A, peripheral nerve (supraorbital nerve, infraorbital nerve and mental nerve) PRF; group B, gasserian ganglion PRF. Follow-up assessments of visual analogue scale (VAS) pain assessment, SF-36 health status questionnaire, total efficiency rate, and drug dosage of anticonvulsants and opioid analgesics were performed at time points of 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. RESULTS: At each postsurgery time point, the VAS decreased, SF-36 (physical and mental components) increased, and drug dosage of anticonvulsants and opioids analgesics decreased in both treatment groups; values at each time point were significantly different from presurgery values ( < 0.05). Compared with group A, VAS decreased, SF-36 increased, and dosage of anticonvulsants and opioids analgesics decreased significantly in group B ( < 0.05). The total efficiency rates one year after surgery in group A and group B were 68.9 and 86.7%, respectively. The total efficiency rate of group B was statistically higher than that of group A ( < 0.05). CONCLUSION: PRF relieved TPHN, and gasserian ganglion PRF was more effective than peripheral nerve PRF. The method was effective and improved the quality of life of the patients. PRF is recommended as a treatment for TPHN.

摘要

目的:三叉神经带状疱疹后神经痛(TPHN)常表现为中度至重度疼痛、痛觉过敏和异常性疼痛。传统镇痛治疗效果不佳,严重影响生活质量。本回顾性研究旨在评估脉冲射频(PRF)治疗TPHN的疗效。 方法:2014年1月至2016年12月期间,在中国医科大学附属盛京医院疼痛管理科选取90例TPHN患者。根据入组顺序将患者随机分为两组(每组n = 45):A组,外周神经(眶上神经、眶下神经和颏神经)PRF;B组,半月神经节PRF。在术后1周、1个月、3个月、6个月和1年时间点进行视觉模拟量表(VAS)疼痛评估、SF - 36健康状况问卷、总有效率以及抗惊厥药和阿片类镇痛药药物剂量的随访评估。 结果:在每个术后时间点,两个治疗组的VAS均降低,SF - 36(生理和心理成分)均升高,抗惊厥药和阿片类镇痛药的药物剂量均降低;各时间点的值与术前值相比差异有统计学意义(P < 0.05)。与A组相比,B组的VAS降低,SF - 36升高,抗惊厥药和阿片类镇痛药的剂量显著降低(P < 0.05)。A组和B组术后1年的总有效率分别为68.9%和86.7%。B组的总有效率在统计学上高于A组(P < 0.05)。 结论:PRF可缓解TPHN,半月神经节PRF比外周神经PRF更有效。该方法有效且改善了患者的生活质量。推荐PRF作为TPHN的一种治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/ebd09f6be05a/fnins-13-00708-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/cf5d612b8dbe/fnins-13-00708-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/35dab3dc8e03/fnins-13-00708-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/78b5e1210e9b/fnins-13-00708-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/e04fc3e8b654/fnins-13-00708-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/ebd09f6be05a/fnins-13-00708-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/cf5d612b8dbe/fnins-13-00708-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/35dab3dc8e03/fnins-13-00708-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/78b5e1210e9b/fnins-13-00708-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/e04fc3e8b654/fnins-13-00708-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eaa9/6630731/ebd09f6be05a/fnins-13-00708-g005.jpg

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本文引用的文献

[1]
Sensory symptom profiles differ between trigeminal and thoracolumbar postherpetic neuralgia.

Pain Rep. 2018-2-6

[2]
Sex differences underlying orofacial varicella zoster associated pain in rats.

BMC Neurol. 2017-5-17

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Treatment of Neuropathic Pain Using Pulsed Radiofrequency: A Meta-analysis.

Pain Physician. 2016

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Pulsed Radiofrequency Reduced Neuropathic Pain Behavior in Rats Associated with Upregulation of GDNF Expression.

Pain Physician. 2016-2

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The Effect of Pulsed Radiofrequency Applied to the Peripheral Nerve in Chronic Constriction Injury Rat Model.

Ann Rehabil Med. 2015-10

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Trigeminal herpes zoster: early recognition and treatment are crucial.

BMJ Case Rep. 2015-3-20

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Pulsed radiofrequency inhibited activation of spinal mitogen-activated protein kinases and ameliorated early neuropathic pain in rats.

Eur J Pain. 2014-5

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BMC Infect Dis. 2014-10-1

[9]
Analysis of T cell responses during active varicella-zoster virus reactivation in human ganglia.

J Virol. 2014-3

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Pulsed radiofrequency modulates pain regulatory gene expression along the nociceptive pathway.

Pain Physician. 2013

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