Department of Pain Medicine, Shenzhen Sixth People's Hospital, Guangdong Medical University, Shenzhen, China.
Department of Pain Medicine, Shenzhen Sixth People's Hospital, Guangdong Medical University, Shenzhen, China; Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Pain Physician. 2020 Mar;23(2):E219-E230.
Some 7.7% of the Chinese population suffer from herpes zoster each year, with 29.8% proceeding on to develop postherpetic neuralgia (PHN). This amounts to over 32 million people per year. PHN is preceded by 2 phases of pain: acute herpetic neuralgia (AHN), and subacute herpetic neuralgia (SHN). Considering the large individual and economic burden, preventing the transition of AHN/SHN to PHN is crucial. However, to date this has been difficult.
To evaluate the efficacy of temporary spinal cord stimulation (tSCS) treatment and prevention of PHN.
A retrospective, observational study.
Department of Pain Medicine.
From 2013 to 2017, 99 patients with AHN (n = 42), SHN (n = 34), and PHN (n = 23) underwent tSCS treatment (7-14 days) after failed pharmacologic and interventional therapies. Visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and analgesic consumption were recorded at baseline, post-tSCS, and 1, 3, 6, and 12 months after tSCS treatment.
Pooled results demonstrated statistically significant decreases in VAS scores and PSQI post-tSCS and at 1, 3, 6, and 12 months follow-up (P < 0.001). When compared with the PHN group, both AHN and SHN groups were clinically and statistically improved in VAS scores and PSQI (P < 0.001). Analgesic consumption decreased in all 3 groups after tSCS treatment, and downward linear gradient of medication in the AHN group was more significant than that in the SHN and PHN groups. At 12 months follow-up, 2.5% (1/40) patients in the AHN group, 16.0% (4/25) in the SHN group, and 62.5% (10/16) in the PHN group had ongoing pain >= 3/10 VAS score requiring analgesia. Expressed differently, at 12 months, 97.5% of the AHN group and 84% of the SHN group had pain of 2/10 VAS score or less versus only 37.5% of the PHN group.
This was a single-center, retrospective study, which made it difficult to collect complete data for all variables. The therapeutic effect of tSCS could not be studied independently.
This retrospective analyses of 99 patients treated with tSCS (7-14 days) suggests that tSCS may be effective for treating and preventing PHN. Early treatment within 4 to 8 weeks was more likely to result in pain <= 2/10 VAS score, improvement in sleep, and no requirement for analgesia at 12 months. Early tSCS may be a promising prevention strategy against the development of chronic neuropathic pain following herpes zoster infection. Further research is justified.
Herpes zoster, zoster-related pain, postherpetic neuralgia, temporary spinal cord stimulation.
中国每年约有 7.7%的人口患有带状疱疹，其中 29.8%会发展为带状疱疹后神经痛（PHN）。这意味着每年有超过 3200 万人受到影响。PHN 之前有两个疼痛阶段：急性带状疱疹神经痛（AHN）和亚急性带状疱疹神经痛（SHN）。考虑到个体和经济负担巨大，预防 AHN/SHN 向 PHN 转变至关重要。然而，迄今为止，这一直是困难的。
评估临时脊髓刺激（tSCS）治疗和预防 PHN 的疗效。
回顾性、观察性研究。
疼痛医学科。
2013 年至 2017 年，99 名 AHN（n = 42）、SHN（n = 34）和 PHN（n = 23）患者在药物和介入治疗失败后接受 tSCS 治疗（7-14 天）。在基线、tSCS 后以及 tSCS 治疗后 1、3、6 和 12 个月记录视觉模拟量表（VAS）、匹兹堡睡眠质量指数（PSQI）和镇痛药消耗。
汇总结果表明，tSCS 后以及 1、3、6 和 12 个月随访时 VAS 评分和 PSQI 均有统计学显著降低（P < 0.001）。与 PHN 组相比，AHN 和 SHN 组的 VAS 评分和 PSQI 均有临床和统计学改善（P < 0.001）。所有 3 组在 tSCS 治疗后镇痛药消耗均减少，AHN 组的药物呈下降线性梯度，比 SHN 和 PHN 组更为明显。在 12 个月随访时，AHN 组有 2.5%（1/40）、SHN 组有 16.0%（4/25）和 PHN 组有 62.5%（10/16）的患者仍有 >= 3/10 VAS 评分的持续性疼痛需要镇痛。换句话说，在 12 个月时，AHN 组 97.5%和 SHN 组 84%的患者疼痛评分 <= 2/10 VAS，而 PHN 组只有 37.5%的患者疼痛评分 <= 2/10 VAS。
这是一项单中心、回顾性研究，难以收集所有变量的完整数据。tSCS 的治疗效果不能独立研究。
对 99 名接受 tSCS（7-14 天）治疗的患者进行回顾性分析表明，tSCS 可能对治疗和预防 PHN 有效。在 4 至 8 周内进行早期治疗更有可能导致 <= 2/10 VAS 评分的疼痛、睡眠改善和 12 个月时无需镇痛药。早期 tSCS 可能是预防带状疱疹感染后慢性神经病理性疼痛发展的一种有前途的策略。需要进一步研究。
带状疱疹、带状疱疹相关疼痛、带状疱疹后神经痛、临时脊髓刺激。
