经皮痛点浸润（TPI）治疗急性和亚急性带状疱疹相关性疼痛的临床疗效：回顾性分析。

Clinical Efficacy of Tender Point Infiltration (TPI)for Management of Acute and Subacute Zoster-Associated Pain: A Retrospective Analysis.

机构信息

Department of Labor Room, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Beijing Tiantan Hospital, Capital Medical University, Department of Pain Management, Beijing, China.

出版信息

Pain Physician. 2023 Mar;26(2):E63-E72.

PMID:36988367

Abstract

BACKGROUND

Zoster-associated pain (ZAP) represents an important medical, social, and economic problem. The treatment approach for ZAP continues to be challenging. Tender point infiltration (TPI) with local anesthetic and steroids has been demonstrated to have potential in the treatment of severe pain, but there are rare reports of the efficacy and security of TPI for acute and subacute ZAP.

OBJECTIVES

The aim of this study was to retrospectively analyze the efficacy of TPI for pain control in acute and subacute ZAP.

STUDY DESIGN

Retrospective case series.

METHODS

Medical records of 152 patients who underwent TPI for acute and subacute herpes zoster pain were reviewed. The patients were divided into 2 groups: acute TPI group (TPI within 30 days after zoster onset) and subacute TPI group (TPI between 30 and 90 days after zoster onset). The numeric rating scale (NRS), effective rate, frequency of TPI and rate of medication discontinuation during the follow-up period of 3 months were retrospectively analyzed.

RESULTS

The NRS score significantly decreased from 7.80 ± 1.05 before TPIs to 0.97 ± 0.68 in the acute TPI group (P < 0.001) and was decreased from 5.76 ± 1.07 to 1.12 ± 0.70 in subacute TPI group (P < 0.001). The effective rate was 92.2% in acute TPI group and was 90.7% in subacute TPI group (P = 0.734). The rate of medication discontinuation at month 1 and month 3 was higher in the acute TPI group than in the subacute TPI group (P < 0.05). The frequency of TPI in acute TPI group (1.49 ± 0.79) was less than subacute TPI group (3.09 ± 1.02) (P < 0.001). A small proportion of the patients had mild complications, and all resolved over time after TPIs. No severe adverse events occurred during or after TPI procedures.

LIMITATIONS

Retrospective design without a control group, short period of follow-up, and the small number of patients.

CONCLUSIONS

TPI can be a useful and safe option for the control of acute and subacute ZAP with high feasibility. Early application of TPI in the acute phase of herpes zoster pain may show better clinical outcomes.

摘要

背景

带状疱疹相关性疼痛（ZAP）是一个重要的医学、社会和经济问题。ZAP 的治疗方法仍然具有挑战性。局部麻醉和皮质类固醇的痛点浸润（TPI）已被证明在治疗严重疼痛方面具有潜力，但很少有报道 TPI 治疗急性和亚急性 ZAP 的疗效和安全性。

目的

本研究旨在回顾性分析 TPI 治疗急性和亚急性带状疱疹相关性疼痛的疗效。

研究设计

回顾性病例系列。

方法

回顾性分析了 152 例因急性和亚急性带状疱疹疼痛而行 TPI 治疗的患者的病历。将患者分为两组：急性 TPI 组（疱疹后 30 天内进行 TPI）和亚急性 TPI 组（疱疹后 30-90 天进行 TPI）。回顾性分析了治疗后 3 个月的数字评分量表（NRS）、有效率、TPI 频率和药物停药率。

结果

急性 TPI 组 NRS 评分从 TPI 前的 7.80 ± 1.05 显著降低至治疗后的 0.97 ± 0.68（P < 0.001），亚急性 TPI 组从 5.76 ± 1.07 降低至 1.12 ± 0.70（P < 0.001）。急性 TPI 组有效率为 92.2%，亚急性 TPI 组为 90.7%（P = 0.734）。急性 TPI 组第 1 个月和第 3 个月的药物停药率高于亚急性 TPI 组（P < 0.05）。急性 TPI 组 TPI 频率（1.49 ± 0.79）低于亚急性 TPI 组（3.09 ± 1.02）（P < 0.001）。少数患者出现轻度并发症，所有并发症均在 TPI 后随时间逐渐缓解。TPI 过程中和 TPI 后均未发生严重不良事件。