Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Pain Physician. 2020 Jan;23(1):65-72.
Acute pain is a risk factor for developing postherpetic neuralgia (PHN), the most common complication of herpes zoster (HZ). Supplemental analgesics are frequently used in the treatment of acute herpetic pain. However, there are insufficient data regarding when to begin supplemental analgesics, and it is unknown whether the delayed use of supplemental analgesics increases the risk of PHN in high-risk patients.
This study aimed to evaluate the association between initial time of supplemental pain management and the risk of PHN in high-risk patients.
Retrospective study.
The Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine.
We performed a retrospective study between May 13, 2017 and August 8, 2018 in our clinic. Multivariable logistic regression analysis was conducted to examine the independent factors associated with PHN. Supplemental pain management was defined as any use of opioids, tricyclic antidepressants, or nerve blocks. A subgroup analysis was conducted in patients who received supplemental pain management within the first 30 days of onset. According to the initial time of supplemental pain management, patients were divided into 2 groups: the early treatment group (<= 14 days), and the late treatment group (> 14 days). The clinical outcomes in these 2 groups was compared for propensity score (PS) matching.
A total of 134 patients with HZ aged 50 years or older with moderate to severe pain were enrolled in this study. The delayed initiation of supplemental pain management (> 14 days) (odds ratio, 4.11; 95% confidence interval, 1.69-9.92; P = 0.002) and severity of rash (odds ratio, 2.93; 95% confidence interval, 1.22-7.01; P = 0.016) were independent factors associated with PHN. In the subgroup analysis, after PS matching, there were no significant differences in the baseline clinical parameters between the early and late treatment groups. The incidence of PHN was significantly lower in the early treatment group than the late treatment group (36. 4% vs. 72.7%; P = 0.015). Reduction in pain was also greater in the early treatment group.
The findings identified in the present study are specific to the patients who were relatively older and with moderate to severe pain. It is impossible to determine from our study whether younger individuals and individuals with mild acute pain will benefit from early supplemental treatments. Furthermore, because of the retrospective nature of the study, there may be some confounders that could not be controlled. Further prospective studies with larger sample sizes and longer follow-up periods are needed.
The early use of supplemental pain management may decrease the risk of PHN. It might therefore be beneficial to consider administering supplemental pain management earlier in older patients with moderate to severe acute herpetic pain.
Herpes zoster, postherpetic neuralgia, analgesia, opioid, nerve block, tricyclic antidepressant.
急性疼痛是带状疱疹后神经痛（PHN）发生的一个危险因素，PHN 是带状疱疹（HZ）最常见的并发症。在治疗急性疱疹疼痛时，经常会使用辅助性镇痛药。然而，关于何时开始使用辅助性镇痛药的数据不足，而且尚不清楚在高危患者中，延迟使用辅助性镇痛药是否会增加 PHN 的风险。
本研究旨在评估高危患者初始时间的辅助性疼痛管理与 PHN 风险之间的关系。
回顾性研究。
浙江大学医学院第二附属医院麻醉与疼痛医学科。
我们于 2017 年 5 月 13 日至 2018 年 8 月 8 日在我们的诊所进行了这项回顾性研究。多变量逻辑回归分析用于检查与 PHN 相关的独立因素。辅助性疼痛管理定义为使用阿片类药物、三环类抗抑郁药或神经阻滞。对在发病后 30 天内接受辅助性疼痛管理的患者进行了亚组分析。根据初始辅助性疼痛管理时间，将患者分为 2 组：早期治疗组（<=14 天）和晚期治疗组（>14 天）。对这两组进行了倾向评分（PS）匹配后的临床结果比较。
共有 134 名年龄在 50 岁及以上、疼痛程度为中度至重度的 HZ 患者纳入本研究。延迟使用辅助性疼痛管理（>14 天）（比值比，4.11；95%置信区间，1.69-9.92；P=0.002）和皮疹严重程度（比值比，2.93；95%置信区间，1.22-7.01；P=0.016）是与 PHN 相关的独立因素。在亚组分析中，经 PS 匹配后，早期和晚期治疗组之间的基线临床参数无显著差异。早期治疗组的 PHN 发生率明显低于晚期治疗组（36.4%比 72.7%；P=0.015）。早期治疗组的疼痛缓解也更大。
本研究确定的结果仅适用于年龄较大且疼痛程度为中度至重度的患者。从我们的研究中无法确定年轻患者和轻度急性疼痛患者是否会从早期辅助治疗中获益。此外，由于研究的回顾性性质，可能存在一些无法控制的混杂因素。需要进一步开展具有更大样本量和更长随访期的前瞻性研究。
早期使用辅助性疼痛管理可能降低 PHN 的风险。因此，对于年龄较大且疼痛程度为中度至重度的急性疱疹患者，考虑早期使用辅助性疼痛管理可能是有益的。
带状疱疹、带状疱疹后神经痛、镇痛、阿片类药物、神经阻滞、三环类抗抑郁药。
