A型肉毒毒素皮下注射治疗带状疱疹后神经痛患者背根神经节脉冲射频术后残余疼痛的效果

Efficacy of subcutaneous injection of botulinum toxin A for residual pain after pulsed radiofrequency to dorsal root ganglion in patients with postherpetic neuralgia

目的评价A型肉毒毒素(BTX-A)皮下注射对带状疱疹后神经痛(PHN)患者背根神经节脉冲射频术(DRG-PRF)治疗后残余疼痛的治疗效果。方法收集2019年9月至2020年3月浙江省人民医院疼痛科收治的PHN患者28例纳入本研究,性别、年龄不限,病程大于3个月,所有患者经规范的药物治疗后数字等级评分(NRS)≥5分。首先选择1~4个"责任神经节段"给予CT引导下DRG-PRF治疗,治疗参数设置为温度42℃、频率2 Hz、脉宽20 ms、电压55~99 V,治疗时间为每节段8 min。治疗后3 d针对残余疼痛区域行BTX-A皮下注射,用生理盐水20 ml对BTX-A 100 U进行稀释,每隔1~2 cm给予BTX-A5U(1 ml)皮下注射,总剂量不超过100 U。采用NRS和睡眠质量评分评估患者术前、PRF治疗后3 d及BTX-A治疗后1周、1个月和3个月时的疼痛强度和睡眠质量,并比较治疗后各随访时点的疼痛缓解≥50%的患者情况。结果28例PHN患者中,26例PRF治疗后存在残余疼痛,进行了BTX-A注射治疗。治疗前、PRF治疗后3 d及BTX-A治疗后7 d、1个月和3个月时的NRS评分分别为(7.5±1.4)、(4.4±1.0)、(2.4±1.1)、(2.2±1.0)和(2.3±1.0)分,治疗后NRS降低,差异有统计学意义(F=88.08,P<0.05)。治疗前、PRF治疗后3 d及BTX-A治疗后7 d、1个月和3个月时的睡眠质量评分分别为(1.2±0.9)、(2.3±1.2)、(3.2±0.9)、(3.4±0.8)和(3.3±1.0)分,治疗后睡眠质量改善,差异有统计学意义(F=38.27,P<0.05)。PRF治疗后3 d及BTX-A治疗后7 d、1个月和3个月时疼痛缓解≥50%的患者比例分别为54%(14/26例)、81%(21/26例)、81%(21/26例)和81%(21/26例)。结论BTX-A皮下注射有助于缓解DRG-PRF治疗后残余疼痛,进一步提高PHN患者的疗效.

Objective To assess the efficacy of subcutaneous injection of botulinum toxin A(BTX-A)for residual pain after pulsed radiofrequency to dorsal root ganglion(DRG-PRF)in patients with postherpetic neuralgia(PHN).Methods Twenty-eight patients with PHN were collected in the Pain Department of Zhejiang Provincial People's Hospital,from September 2019 to March 2020.Sex and age were not limited,and the average diseased course was more than 3 months.Numerical rating scale(NRS)of every patient's pain was still not less than 5 scales after the standard drug treatment.Firstly,CT-guided PRF of one to four involved DRG was performed.The treatment parameters were set as temperature 42℃,frequency 2 Hz,pulse width 20 ms,voltage 55-99 V and treatment time 8 minutes.Three days later,BTX-A was injected into the residual pain area in a chessboard manner.100 U of BTX-A was reconstituted with 20 ml of 0.9%NaCl.The injection dosage was 5 U(1 ml)1-2 cm apart and the total dosage was not more than 100 U.Pain intensity and sleep quality were assessed respectively by NRS and sleep quality scale at baseline,3 days after PRF and 1 week,1 month and 3 months after BTX-A treatment.The percentage of patients with≥50%decrease in NRS at different follow-up time points was also compared.Results There were 26 cases received BTX-A for residual pain after PRF treatment in 28 patients with PHN.NRS was(7.5±1.4),(4.4±1.0),(2.4±1.1),(2.2±1.0)and(2.3±1.0)(F=88.08,P<0.05)respectively,and sleep quality scale was(1.2±0.9),(2.3±1.2),(3.2±0.9),(3.4±0.8)and(3.3±1.0)(F=38.27,P<0.05)at baseline,3 days after PRF,7 days,1 month and 3 months after BTX-A injection respectively.The rate of pain relief≥50%was 54%(14/26 cases),81%(21/26 cases),81%(21/26 cases)and 81%(21/26 cases)respectively at 3 days after PRF,1 week,1 month and 3 months after BTX-A treatment.Conclusions Subcutaneous injection of BTX-A is helpful to relieve residual pain after DRG-PRF and further improve the efficacy of patients with PHN.