Dieckmann Gabriela, Ozmen M Cuneyt, Cox Stephanie M, Engert Ryan C, Hamrah Pedram
Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical, USA.
Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, USA.
Ocul Surf. 2021 Apr;20:33-38. doi: 10.1016/j.jtos.2020.12.003. Epub 2021 Jan 12.
Neuropathic corneal pain (NCP) is caused by damage or disease of the somatosensory nervous system that innervates the cornea and presents with symptoms of pain or persistent unpleasant sensations, such as burning, dryness, or light sensitivity. This retrospective study aims to assess the efficacy and tolerability of low-dose naltrexone (LDN) in refractory NCP patients.
Fifty-nine NCP patients with a centralized component treated with oral LDN 4.5 mg at bedtime for at least four weeks were identified. Thirty out of 59 patients who had a baseline pain score ≥4 on the visual analogue scale had completed the ocular pain assessment survey (OPAS) and presented persistent pain, despite instillation of topical anesthetic drops, were included. Changes in pain scores, comorbidities, side effects, among others, were analyzed. Change in ocular pain scores (scale 0-10) and quality of life (QoL) scores (scale 0-100%) were the main endpoints.
Mean age (years ± SD) was 45.60 ± 19.30 with a white (80.00%) female (73.33%) predominance. Duration of LDN use was 14.87 ± 11.25 months, and the duration of NCP before treatment was 17.53 ± 17.29 months. Eight patients used LDN as a monotherapy, whereas the remaining used it as an adjunct therapy. LDN resulted in a 49.22% decrease in mean pain score from 6.13 ± 1.93 to 3.23 ± 2.60 (p < 0.001). Mean QoL scores by the OPAS were 5.84 ± 2.57 at the first visit and improved to 3.77 ± 2.91 at the last visit (p = 0.023). Common side effects were vivid dreams, headaches, and stomachache.
LDN was effective and well-tolerated for NCP treatment.
神经性角膜疼痛（NCP）由支配角膜的躯体感觉神经系统损伤或疾病引起，表现为疼痛症状或持续的不适感，如灼烧感、干涩感或对光敏感。这项回顾性研究旨在评估低剂量纳曲酮（LDN）对难治性NCP患者的疗效和耐受性。
确定了59例接受口服LDN 4.5毫克、每晚一次、治疗至少四周且有集中成分的NCP患者。59例患者中，30例在视觉模拟量表上基线疼痛评分≥4，尽管使用了局部麻醉滴眼液仍有持续性疼痛，完成了眼痛评估调查（OPAS），纳入分析疼痛评分、合并症、副作用等方面的变化。眼痛评分（0 - 10分）和生活质量（QoL）评分（0 - 100%）的变化是主要终点。
平均年龄（岁±标准差）为45.60±19.30，以白人（80.00%）女性（73.33%）为主。LDN使用时间为14.87±11.25个月，治疗前NCP持续时间为17.53±17.29个月。8例患者将LDN作为单一疗法使用，其余患者将其作为辅助疗法使用。LDN使平均疼痛评分从6.13±1.93降低了49.22%，降至3.23±2.60（p < 0.001）。OPAS评估的平均QoL评分在首次就诊时为5.84±2.57，在最后一次就诊时提高到3.77±2.91（p = 0.023）。常见副作用为生动梦境、头痛和胃痛。
LDN对NCP治疗有效且耐受性良好。
