毫火针配合温和灸治疗带状疱疹后神经痛临床研究

Clinical research on fire filiform needle combined with mild moxibustion for postherpetic neuralgia

目的:比较毫火针加温和灸法与加巴喷丁配合假针刺治疗带状疱疹后神经痛(PHN)的疗效差异。方法:将100例PHN患者随机分为毫火针组和西药组,每组50例。毫火针组在局部阿是穴处行毫火针点刺治疗后,行温和灸15min;西药组采用加巴喷丁胶囊口服,配合假针刺(病灶远端非穴点浅刺)治疗。针刺治疗前3天每天1次,以后隔天1次,6次为1疗程,疗程间隔2天,两组均治疗2个疗程。记录治疗前及第1、2、3、6、9、12次治疗后各时点的疼痛VAS评分,观察患者过去24h内最痛程度、现在疼痛程度、即刻止痛疗效、疼痛开始缓解时间等,并进行疗效评价及随访观察症状改善情况。结果:毫火针组总有效率为94.0%(47/50),优于西药组的86.0%(43/50,P<0.05)。毫火针组患者过去24h内最痛程度VAS评分从第2次治疗开始、现在疼痛程度VAS评分从第1次治疗开始,均较西药组明显降低(均P<0.05)。在前3次治疗中毫火针组的即刻止痛效果明显优于西药组(均P<0.05)。毫火针组的疼痛缓解时间平均为(3.91±0.82)天,明显早于西药组的(6.53±1.13)天(P<0.05)。随访时毫火针组痊愈26例,明显多于西药组的2例(P<0.05);在疼痛积分、疼痛范围及睡眠质量改善方面亦优于西药组(均P<0.05)。毫火针组直接医疗费用为(232.32±48.11)元,明显少于西药组的(466.00±41.09)元(P<0.05)。治疗中仅西药组出现1例药物不良反应。结论:毫火针加温和灸能明显缓解PHN患者的疼痛,即刻止痛效果好,疼痛缓解起效时间早,优于加巴喷丁,且不良反应少、价格便宜。

Objective To compare efficacy differences between fire filiform needle combined with mild moxi- bustion and gabapentin combined with sham acupuncture for postherpetic neuralgia （PHN）. Methods One hun- dred cases of PHN were randomly divided into a needle group and a medicine group, 50 cases in each one. In the needle group, pricking method of fire filiform needle was given at the Ashi points, and then mild moxibustion was applied for 15 min. In the medicine group, the oral administration of gabapentin capsule and sham acupuncture at non-acupoints in the distal end of lesions were applied. The treatment was required for 21 days in both groups. The visual analogue score （VAS） was recorded before treatment and on the 1st day, 2nd day, 3rd day, 6th day, 9th day and 12th day of treatment. The most severity of pain within last 24 h, present severity of pain, immediate analgesia effect and starting time of pain relief were observed, also the efficacy was assessed and improvement of symptoms was observed in the follow-up visit. Results The total effective rate was 94.0% （47/50） in the fire fili-form needle group, which was superior to 86.0% （43/50） in the medicine group （P〈0.05）. Compared with medicine group, the VAS of the most severity of pain within last 24 h was obviously reduced after the 2nd treat- ment in the fire filiform needle group while that of present severity of pain was relieved after the 1st treatment （both P〈0.05）. The immediate analgesia effect in the fire filiform needle group was obviously superior to that in the medicine group in the first three times of treatment （all P〈0.05）. The average time of pain relief was （3.91± 0.82） days in the fire filiform needle group, which was significantly earlier to （6.53±1.13） days in the medicine group （P〈0.05）. 26 cases were cured in the fire filiform needle group in the follow-up visit, which was superior to 2 cases in the medicine group （P〈0.05）. The improvement of VAS, pain range and sleep quality in the needle group were also superior to those in the medicine group （all P〈0.05）. The direct me-dical cost in the fire filiform needle group was （232. 32±48. 108） yuan, which was significantly lower than （466.00 ±41.09） yuan in the medicine group （P〈0.05）. There was only one case of adverse effect in the medicine group during the treatment. Conclusion The fire filiform needle combined with mild moxibustion could obviously relieve the pain in PHN patients, which has superior immediate analgesia effect and pain relieving time compared with gabapentin, which also has less adverse effects and cheap cost.