丁丙诺啡透皮贴联合加巴喷丁用于脊柱退变相关疼痛的临床观察

Therapeutic Effect of Transdermal Patch of Buprenorphine Combined with Gabapentin on Pain from Spinal Degenerative Disease

目的观察丁丙诺啡透皮贴联合加巴喷丁胶囊对老年脊柱退行性病变相关疼痛,尤其神经病理性痛的疗效。方法将河南省安阳市人民医院在2013年12月~2014年12月期间明确诊断为脊柱退变引起的疼痛患者54例随机分成两组：A组（n=27）采用丁丙诺啡透皮贴联合加巴喷丁胶囊进行药物治疗,B组（n=27）采用经典非甾体消炎镇痛药（NSAIDs）进行治疗;同时对两组患者进行健康宣教和康复训练。用简化麦吉尔疼痛问卷（SF-MPQ）评价两组患者14d内疼痛评估指数（PRI）;记录静息和运动时的疼痛强度评分（VAS）,监测用药前、用药后7d患者的血浆炎症因子（血浆P物质、C反应蛋白、IL-6）浓度,并观察用药后出现的恶心、呕吐、头晕、呼吸抑制等不良反应。结果用药24h后两组PRI、VAS出现差异（均P〈0.05）,血浆炎性因子在用药7d后出现差异（均P〈0.05）,两组患者均无呼吸抑制。A组曾出现5例头晕、嗜睡,与加巴喷丁有关;B组出现13例恶心、呕吐,21例盘源性神经病理性痛症状无法缓解。结论丁丙诺啡透皮贴联合加巴喷丁胶囊在镇痛效果、不良反应和依从性方面占优势,对脊柱退变相关神经病理性痛症状控制针对性强。

Objective To evaluate the therapeutic effect of transdermal patch of buprenorphine combined with gabapentin on pain,especially,neuropathic pain related to spinal degenerative disease.Methods Totally,54 patients who were diagnosed as spinal degenerative disease in our hospital from December 2013 to December 2014 for treating pain were enrolled in our study and randomly divided into two groups：group A（n=27）,patients were treated with transdermal patch of buprenorphine combined with gabapentin;group B（n=27）,patients were treated with conventional NSAIDs.At the same time,patients in the two groups received training of health education and rehabilitation.Then pain rating index（PRI）within 14 days was evaluated by short-form of McGill pain questionnaire（SF-MPQ）and pain intensity scores（VAS）at rest and during exercise were recorded.Concentrations of plasma inflammatory cytokines（including plasma substance P,C-reactive protein,IL-6）were monitored before and 7days after the treatment.Adverse drug reactions such as nausea,vomiting,dizziness,respiratory inhibition were observed.Results PRI and VAS were significantly different between the two groups 24 hafter the treatment（P〈0.05）.Plasma inflammatory cytokines were significantly different between the two groups after 7days of treatment（P〈0.05）.There was no respiratory inhibition in the two groups.But dizziness and sleepiness were found in 5cases of group A,which was thought to be related to gabapentin.In group B,nausea and vomiting were found in 13 cases and discogenic neuropathic pain did not be successfully relieved in 21 cases.Conclusion Transdermal patch of buprenorphine combined with gabapentin have better analgesic effects,less adverse reactions,and better compliance.It is good in pertinence in treating neuropathic pain from spinal degenerative disease.