Titus Joane, Sarmiento Bernard, Crouse Roger
Medicine, University of Central Florida College of Medicine, Orlando, USA.
Neurology, University of Central Florida College of Medicine, Orlando, USA.
Cureus. 2024 Jul 12;16(7):e64432. doi: 10.7759/cureus.64432. eCollection 2024 Jul.
Guillain-Barre syndrome (GBS) is an acute post-infectious polyradiculoneuropathy characterized by autoantibodies targeting host antigens, resulting in nerve fiber demyelination and axonal degeneration. While symmetric ascending weakness is typical, neuropathic pain is a common yet variable manifestation. We present a case of a 52-year-old man with progressive bilateral leg weakness and severe neuropathic pain following a flu-like illness. Despite conventional analgesics, his pain persisted, necessitating a unique pain management approach. The patient's examination revealed hyporeflexia and sensory deficits consistent with GBS. Diagnostic workup, including lumbar puncture, showed albuminocytologic dissociation. Plasma exchange therapy was initiated, but severe nocturnal neuropathic pain persisted, exacerbating during treatment. Conventional pain medications were ineffective, prompting a multimodal approach. Combining hydromorphone and lorazepam provided significant pain relief, enabling completion of plasmapheresis sessions. This regimen, supplemented with gabapentin, proved effective in managing both GBS-associated and treatment-induced pain. This case underscores the debilitating nature of GBS-related pain and the importance of tailored pain management strategies. While conventional agents may fail, a multimodal approach, including opioids and adjunctive medications, can offer relief, facilitating essential treatments like plasmapheresis. Careful monitoring is imperative to mitigate risks associated with potent analgesics. Our experience contributes to the armamentarium for managing GBS-related pain, emphasizing individualized care to improve patient outcomes.
吉兰-巴雷综合征（GBS）是一种急性感染后多神经根神经病，其特征是自身抗体靶向宿主抗原，导致神经纤维脱髓鞘和轴突变性。虽然对称性上行性无力是典型表现，但神经性疼痛是一种常见且多变的症状。我们报告一例52岁男性病例，该患者在患流感样疾病后出现进行性双侧腿部无力和严重的神经性疼痛。尽管使用了传统镇痛药，但其疼痛仍持续存在，需要采用独特的疼痛管理方法。患者的检查显示腱反射减退和感觉缺陷，与GBS相符。包括腰椎穿刺在内的诊断性检查显示蛋白细胞分离。开始进行血浆置换治疗，但严重的夜间神经性疼痛仍持续存在，在治疗期间加重。传统的止痛药物无效，促使采用多模式方法。将氢吗啡酮和劳拉西泮联合使用可显著缓解疼痛，使血浆置换疗程得以完成。辅以加巴喷丁的这一治疗方案在管理GBS相关疼痛和治疗引起的疼痛方面均被证明有效。该病例强调了GBS相关疼痛的致残性以及量身定制疼痛管理策略的重要性。虽然传统药物可能无效，但包括阿片类药物和辅助药物在内的多模式方法可以缓解疼痛，促进诸如血浆置换等必要治疗。必须进行仔细监测以降低与强效镇痛药相关的风险。我们的经验为管理GBS相关疼痛的方法库做出了贡献，强调个性化护理以改善患者预后。
