Li Xin-Long, Zeng Xu, Zeng Shan, He Hai-Ping, Zeng Zhen, Peng Li-Lei, Chen Li-Gang
Department of Neurosurgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China.
Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China.
Exp Ther Med. 2020 Feb;19(2):1058-1064. doi: 10.3892/etm.2019.8301. Epub 2019 Dec 9.
The present meta-analysis study aimed to investigate the safety and efficacy of local administration of botulinum toxin (BTX-A) vs. lidocaine in the treatment of post-herpetic neuralgia. A systematic search of the Cochrane Library, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, Chongqing VIP Information Co. and Chinese Biomedical Literature Database was performed to identify randomized controlled trials (RCTs) comparing BTX-A and lidocaine in the treatment of post-herpetic neuralgia. The primary outcomes were Visual Analogue Scale (VAS) pain scores at 1, 2 and 3 months after treatment and the effective rate. Secondary outcomes were scores on the McGill pain questionnaire and adverse event rate. A total of 7 RCTs comprising 752 patients were included. The VAS pain score was significantly lower at 1 month [mean difference (MD)=-2.31; 95% CI: -3.06, -1.56; P<0.00001)], 2 months (MD=-2.18; 95% CI: -2.24, -2.11; P<0.00001) and 3 months (MD=-1.93; 95% CI: -3.05, -0.82; P=0.0007) after treatment, the effective rate was significantly higher (odds ratio=2.9; 95% CI: 1.71, 4.13; P<0.0001) and scores on the McGill pain questionnaire were significantly lower (MD=-10.93; 95% CI: -21.02, -0.83; Z=2.12; P=0.03) in patients who received BTX-A for post-herpetic neuralgia compared to those who received lidocaine. There was no difference in the adverse event rate between treatments. In conclusion, BTX-A has potential as a safe and effective treatment option for post-herpetic neuralgia. Further large and well-designed RCTs are required to confirm this conclusion.
本荟萃分析研究旨在探讨局部注射肉毒杆菌毒素（BTX-A）与利多卡因治疗带状疱疹后神经痛的安全性和有效性。通过系统检索Cochrane图书馆、PubMed、Embase、中国知网、万方、维普资讯和中国生物医学文献数据库，以识别比较BTX-A和利多卡因治疗带状疱疹后神经痛的随机对照试验（RCT）。主要结局指标为治疗后1、2和3个月时的视觉模拟评分（VAS）疼痛评分及有效率。次要结局指标为麦吉尔疼痛问卷评分及不良事件发生率。共纳入7项RCT，涉及752例患者。与接受利多卡因治疗的患者相比，接受BTX-A治疗带状疱疹后神经痛的患者在治疗后1个月（平均差值[MD]=-2.31；95%置信区间：-3.06，-1.56；P<0.00001）、2个月（MD=-2.18；95%置信区间：-2.24，-2.11；P<0.00001）和3个月（MD=-1.93；95%置信区间：-3.05，-0.82；P=0.0007）时的VAS疼痛评分显著更低，有效率显著更高（优势比=2.9；95%置信区间：1.71，4.13；P<0.0001），麦吉尔疼痛问卷评分显著更低（MD=-10.93；95%置信区间：-21.02，-0.83；Z=2.12；P=0.03）。治疗间不良事件发生率无差异。总之，BTX-A有潜力成为治疗带状疱疹后神经痛的安全有效选择。需要进一步开展大规模、设计良好的RCT来证实这一结论。
