调神针法对带状疱疹后遗神经痛患者疼痛程度、负性情绪和睡眠质量的影响

Effects of mind-regulating acupuncture on pain,negative emotion and sleep quality in patients with postherpetic neuralgia:a randomized controlled pilot trial

目的:观察调神针法对带状疱疹后遗神经痛(PHN)患者疼痛程度、睡眠质量、负性情绪的影响,评价调神针法联合阿是穴围刺、重灸治疗PHN的临床疗效。方法:将PHN患者随机分为对照组(35例,脱落2例)和综合组(35例)。对照组采用阿是穴围刺配合重灸治疗,综合组在此基础上施以调神针法,两组每日治疗1次,6 d为1个疗程,疗程间休息1 d,共治疗2个疗程。分别在治疗前后采用疼痛分级指数(PRI)、视觉模拟量尺(VAS)评分和现有疼痛强度(PPI)评分评估两组患者疼痛情况;采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估患者负性情绪;采用匹兹堡睡眠量表(PSQI)评估患者睡眠质量。记录患者治疗前和治疗结束后1周内的平均睡眠时间。对两组作疗效评估。在治疗结束2个月后对两组有效病例随访,评估记录神经痛复发情况。结果:两组患者治疗前的各项指标差异无统计学意义,具有可比性。治疗后,两组患者PRI、VAS、PPI、HAMA、HAMD、PSQI评分均较治疗前降低(P<0.05),平均睡眠时间增加(P<0.05);两组组间比较,综合组PRI、VAS、PPI、HAMA、HAMD、PSQI评分及平均睡眠时间的改善均优于对照组(P<0.05)。综合组总有效率(34/35,97.14%)高于(P<0.05)对照组(27/33,81.82%),复发率(2/34,5.88%)远低于(P<0.05)对照组(8/27,29.63%)。结论:调神针法联合阿是穴围刺、重灸可以有效缓解PHN,相比单纯阿是穴围刺、重灸,该疗法改善疼痛程度、睡眠质量、负性情绪的效果更好,且可减少复发。

Objective To observe the effect of mind-regulating acupuncture on pain intensity,sleep quality,negative emotion in patients with postherpetic neuralgia(PHN),and evaluate the clinical effect of mind-regulating acupuncture combined with surrounding needling and heavy moxibustion at Ashi points(Extra) in treatment of PHN.Methods The patients with PHN were randomly divided into a control group(35 cases,2 cases dropped out) and a comprehensive therapy group(35 cases).The patients in the control group were treated with surrounding needling and heavy moxibustion at Ashi points.In the comprehensive therapy group,the mind-regulating acupuncture therapy was delivered besides the treatment as the control group.The treatment was given once daily,one course of treatment was composed of 6 days and 2 courses were required in the 2 groups.Before and after treatment,the pain conditions were assessed using pain rating index(PRI),visual analogue scale(VAS) and present pain intensity(PPI),the negative emotions were assessed using Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD),and the sleep quality with Pittsburgh sleep quality index(PSQI).One week before and one week after treatment,the average sleep time was recorded.The therapeutic effect of 2 groups was evaluated.The effective cases of 2 groups were followed up in 2 months after treatment completion and the recurrence of neuralgia was recorded.Results There were no statistical differences in the above indicators between the 2 groups before treatment.After 2 courses of treatment,the scores of PRI,VAS,PPI,HAMA,HAMD and PSQI were reduced when compared with those before treatment in the patients of the 2 groups(P<0.05),and the average sleep time was increased(P<0.05).The scores of PRI,VAS,PPI,HAMA,HAMD and PSQI in the comprehensive therapy group,as well as the average sleep time were all improved when compared with those of the control group(P<0.05).The total effective rate in the comprehensive therapy group(34/35,97.14%) was higher than that of the control group(27/33,81.82%,P<0.05) and the recurrence rate was lower([2/34,5.88%]vs[8/27,29.63%],P<0.05).Conclusion The combination of mind-regulating acupuncture with surrounding needling and heavy moxibustion at Ashi acupoint can effectively relieve PHN.Compared with the traditional surrounding acupuncture in pain area combined with moxibustion at Ashi points,this comprehensive therapy is more effective for ameliorating pain intensity,improving sleep quality and reducing negative emotions.It is also effective for declining the recurrence.