Guo Zhen, Xia Yunfan, Zhang Zuyong
The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
Front Pharmacol. 2025 Jul 30;16:1614587. doi: 10.3389/fphar.2025.1614587. eCollection 2025.
Postherpetic neuralgia (PHN) is a neuropathic pain and the most common complication of herpes zoster (HZ). Pharmacotherapy serves as the primary intervention for alleviating pain associated with PHN.
Electronic databases were systematically searched to identify randomized controlled trials (RCTs) evaluating pharmacotherapy for PHN. The network meta-analysis (NMA) based on the Bayesian framework was analyzed using R4.4.1 and Stata18.0 software.
A total of 38 RCTs were included in the analysis, enrolling 8,621 participants. In the Risk of Bias 2.0 (RoB 2.0) tool, nine studies (24%) were assessed as having a high risk of bias, 15 studies (39%) were rated as having some concerns, and 14 studies (37%) were assessed as having a low risk of bias. The NMA results showed that the NGX-4010 8% capsaicin patch had a statistically significant effect in terms of pain intensity (MD = -9.20, 95% CI: [-12.0, -6.60]). The secondary outcomes showed a significant effect of hydromorphone in improving sleep quality (MD = -3.8, 95% CI: [-23.0, -15.0]) and decreasing pain questionnaire scores (MD = -13.0, 95% CI: [-28.0, 2.1]). Amitriptyline plus pregabalin demonstrated the highest probability of clinical superiority (SUCRA = 0.92). The AE incidence results showed that opioids were identified as having the highest cumulative ranking (SUCRA = 0.87).
The study showed that capsaicin patches and hydromorphone were more significant in relieving pain in PHN, whereas calcium channel modulators were more comprehensive in clinical management. The inclusion of more high-quality articles was needed to support this evidence due to quality bias in the literature.
带状疱疹后神经痛（PHN）是一种神经性疼痛，也是带状疱疹（HZ）最常见的并发症。药物治疗是缓解PHN相关疼痛的主要干预措施。
系统检索电子数据库，以识别评估PHN药物治疗的随机对照试验（RCT）。使用R4.4.1和Stata18.0软件对基于贝叶斯框架的网络荟萃分析（NMA）进行分析。
分析共纳入38项RCT，涉及8621名参与者。在偏倚风险2.0（RoB 2.0）工具中，9项研究（24%）被评估为具有高偏倚风险，15项研究（39%）被评为有一些担忧，14项研究（37%）被评估为具有低偏倚风险。NMA结果显示，8%辣椒素贴剂NGX-4010在疼痛强度方面具有统计学显著效果（MD = -9.20，95% CI：[-12.0，-6.60]）。次要结果显示，氢吗啡酮在改善睡眠质量（MD = -3.8，95% CI：[-23.0，-15.0]）和降低疼痛问卷评分（MD = -13.0，95% CI：[-28.0，2.1]）方面有显著效果。阿米替林加普瑞巴林显示出临床优越性的最高概率（SUCRA = 0.92）。不良事件发生率结果显示，阿片类药物被确定为累积排名最高（SUCRA = 0.87）。
该研究表明，辣椒素贴剂和氢吗啡酮在缓解PHN疼痛方面更显著，而钙通道调节剂在临床管理中更全面。由于文献中的质量偏倚，需要纳入更多高质量文章来支持这一证据。
