Chiou-Tan F Y, Tuel S M, Johnson J C, Priebe M M, Hirsh D D, Strayer J R
Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas 77004, USA.
Am J Phys Med Rehabil. 1996 Mar-Apr;75(2):84-7. doi: 10.1097/00002060-199603000-00002.
Severe pain occurs in 5-30% of the spinal cord-injured (SCI) population and is difficult to treat. Subarachnoid lidocaine has been used in selected patients with some success. Mexiletine, an analog of lidocaine that acts at Na+/K+ channels in the peripheral nerve, has been found effective in persons with diabetic dysesthetic neuropathy. The effect of mexiletine in the treatment of spinal cord dysesthetic pain was examined in this study. Fifteen patients were enrolled, and 11 patients completed the prospective, randomized, placebo-controlled, double-blind, crossover design trial. Inclusion/exclusion criteria were carefully defined. A 1-wk washout period was followed by a 4-wk drug trial of either mexiletine (450 mg/day) or placebo. This was repeated for the second medication in the second arm of the study. Patients were followed weekly with McGill and visual analog pain scales. Baseline, midpoint, and endpoint Barthel function scores were recorded. The Wilcoxon's signed-rank test and paired t test were used for statistical analysis. Results showed no significant effect of mexiletine on SCI dysesthetic pain scales or Barthel index. In conclusion, in this trial, mexiletine did not appear to decrease spinal cord injury-related dysesthetic pain.
5%至30%的脊髓损伤（SCI）患者会出现剧痛，且难以治疗。蛛网膜下腔注射利多卡因已用于部分患者并取得了一定成效。美西律是利多卡因的类似物，作用于周围神经的钠/钾通道，已被发现对糖尿病性感觉异常性神经病变患者有效。本研究考察了美西律治疗脊髓感觉异常性疼痛的效果。招募了15名患者，11名患者完成了这项前瞻性、随机、安慰剂对照、双盲、交叉设计试验。仔细定义了纳入/排除标准。经过1周的洗脱期后，进行为期4周的美西律（450毫克/天）或安慰剂药物试验。在研究的第二组中对第二种药物重复此过程。每周用麦吉尔疼痛量表和视觉模拟疼痛量表对患者进行随访。记录基线、中点和终点的巴氏功能评分。采用威尔科克森符号秩检验和配对t检验进行统计分析。结果显示，美西律对SCI感觉异常性疼痛量表或巴氏指数无显著影响。总之，在本试验中，美西律似乎并未减轻脊髓损伤相关的感觉异常性疼痛。
