Clinical Experience of Pain Treatment for Postherpetic Neuralgia in Elderly Patients

治療老人帶狀疱疹後神經痛之臨床經驗

周笑華(Siu-Wah Chau) ； 蘇理盈(Lee-Ying Soo) ； 盧偉(David Vi Lu) ； 陳太乙(Tai-I Chen) ； 程廣義(Kuang-I Cheng) ； 朱光興(Koung-Shing Chu)

《Acta Anaesthesiologica Taiwanica》 45卷2期 (2007/06) Pp. 95-101

摘要

背景：帶狀疱疹後神經痛為急性帶狀疱疹感染後引發延續的神經痛症候群，其難於治癒的疼痛成為臨床醫療的一大困擾。此類老年病人常因疼痛而導致心情不快、起居不便而降低生活品質。本研究以回顧方式評估在高雄醫學大學附設醫院疼痛科門診，治療老人帶狀疱疹後神經痛之效果。
方法：自2004年1月至2006年6月間收集58例年齡大於65歲，在疼痛科門診求診之帶狀疱疹後神經痛病人作評估。治療前與後之疼痛程度均由病人自己以numeric pain scale (NPS)評估。治療方法包括藥物治療和神經阻斷術。藥物以gabapentin和鴉片類止痛劑為主，非類固醇抗發炎藥作輔助。神經阻斷術則按疼痛部位，從開始治療，每週施行2次。治療效果分別在1個月及3個月後（或最後一次門診），病人自己以疼痛緩解情況及尚存疼痛程度來評估。治療期間的副作用也加以分析。
結果：(1)病人的平均年齡為75.1歲。發生率以70-79歲年齡層最多(65.5%)，且各年齡層都是女性人數較男性為多。最常侵犯胸部皮節(82.7%)。(2)治療前病人之疼痛程度評估均達劇痛(NPS 8-10)。(3)藥物治療方面，所有病人都接受抗痙攣藥gabapentin，98.3%病人同時需鴉片類止痛劑，還有些病人另需非類固醇抗發炎藥。(4)副作用以思睡最多(24.1%)。(5)神經阻斷術中以肋間神經阻斷術施行最多(84.5%)。(6)治療效果以疼痛緩解程度來評估，高達46例(79.3%)及57例(98.3%)分別於治療1個月及3個月後獲得中度以上疼痛緩解。雖然沒有病人獲得完全緩解，但其尚存疼痛為微痛(NPS 1-3)者，治療1個月後有12例(20.7%)，3個月後則高達45例(77.6%)。(7)統計數值顯示，治療前後疼痛程度有有意義的緩解。
結論：我們的結果顯示，以同時組合式療法投予適當藥物，加上施行恰當神經阻斷術，大部分的帶狀疱疹後神經痛老人能獲得滿意之疼痛緩解。

關鍵字

帶狀疱疹後神經痛 ； 止痛 ； 老年的

並列摘要

Background: Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following acute herpes zoster infection. The main clinical problem is intractable pain which interferes with activity of daily life and reduces the quality of life in the elderly patients. This retrospective study was to evaluate the outcome of pain treatment for the elderly patients with PHN at the Pain Clinic of Kaohsiung Medical University Hospital.
Methods: Fifty-eight elderly outpatients with PHN were studied from January 2004 to June 2006. The pain intensity before and after treatment were assessed by patients themselves with numeric pain scale (NPS). The pain treatment included (1) medication with anticonvulsants, opioids and nonsteroidal anti-inflammatory drugs (NSAIDs); (2) nerve block with 0.25% bupivacaine or 1% lidocaine twice a week at the beginning of the treatment. The therapeutic outcome was expressed by pain relief. The reduction of pain and residual pain intensity were evaluated subjectively by the patients themselves with patients' global impression and NPS, respectively, after treatment for one and three months (or last visit). The adverse events throughout the treatment course were analyzed.
Results: (1) The mean age of the patients was 75.1 yr. The number of female PHN sufferers was higher than that of male in all aged groups and the highest incidence was found in the age group of 70-79 (65.5%). The most commonly involved dermatomes were in the thoracic region (82.7%). (2) All patients suffered from severe pain (NPS 8-10) before treatment. (3) The pain management was a combination of medication and nerve block at the beginning of the treatment. Among the medications, gabapentin was prescribed to all the patients and almost all of them (98.3%) required opioids simultaneously and some of them needed additional NSAIDs at the beginning of the treatment. (4) The most common adverse event was somnolence (24.1%). (5) Among the sympathetic blocks, the intercostal nerve block was performed commonly (84.5%). (6) The therapeutic outcome was expressed by pain relief. As to the reduction of pain, 46 cases (79.3%) and 57 cases (98.3%) felt moderate andmuch improvement after treatment for one and three months (or last visit), respectively. As to residual pain intensity, although none of them got complete pain relief, however, there were 12 cases (20.7%) and 45 cases (77.6%) felt the pain intensity was mild (NPS 1-3) after treatment for one and three months respectively. (7) There was a statistically significant decrease in the pain intensity between before treatment and after treatment for one month and three months.
Conclusions: Our study results showed that the concurrent combination therapy with proper medications and appropriate nerve blocks could offer satisfactory pain relief in the majority of elderly patients with PHN.

並列關鍵字

Neuralgia, postherpetic ； Analgesia ； Aged