A qualitative study of the psychological processes in patients with post-herpetic neuralgia

Objective:To understand the psychological process of patients with post-herpetic neuralgia(PHN)and provide references for the psychological management of PHN.Methods:The objective sampling method was used to conduct semi-structural in-depth interviews on 10 PHN patients,and Colaizzi’s phenomenological analysis method was used for data analysis.Results:According to the different pain durations of PHN patients,the patients were divided into three stages and five themes were extracted:the need for strong pain relief,the helpless tolerance of pain,the self-feeling burden,the need for health education,and the positive response to pain.Conclusions:PHN has complex psychological activities,so it is necessary to pay attention to the psychological process of patients and take effective psychological measures to intervene negative psychology so that patients can actively cope with the pain.

Correlation of p38MAPK,ERK1/2 and JNK expression in peripheral blood with the cytokines and pain mediators in patients with post-herpetic neuralgia

Objective: To study the correlation of p38MAPK, ERK1/2 and JNK expression in peripheral blood with the cytokines and pain mediators in patients with post-herpetic neuralgia (PHN). Methods: Patients who were diagnosed with herpes zoster for the first time in the Second Hospital of Hanbin District Ankang City between March 2015 and April 2016 were selected and divided into the PHN group who were combined with post-herpetic neuralgia and the pure HZ group who were without neuralgia, and the healthy volunteers who received physical examination in the Second Hospital of Hanbin District Ankang City during the same period were selected as control group. The peripheral blood was collected to determine the expression of MAPK signaling molecules, and serum was collected to determine the contents of cytokines and pain mediators. Results: p38MAPK, ERK1/2 and JNK mRNA expression in peripheral blood as well as 5-HT, CGRP, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum of PHN group and HZ group were significantly higher than those of control group while β-EP levels were significantly lower than that of control group;p38MAPK, ERK1/2 and JNK mRNA expression in peripheral blood as well as 5-HT, CGRP, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum of PHN group were significantly higher than those of HZ group while β-EP level was significantly lower than that of HZ group. p38MAPK, ERK1/2 and JNK expression in peripheral blood of PHN patients were positively correlated with CGRP, 5-HT, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum, and negatively correlated with β-EP level in serum. Conclusion: The high expression of p38MAPK, ERK1/2 and JNK in peripheral blood of PHN patients can increase the secretion of cytokines and algogenic mediators and decrease the secretion of analgesic mediators.

Correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster

Objective:To study the correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster.Methods:Patients diagnosed with herpes zoster in our hospital between May 2012 and October 2015 were selected and divided into herpes zoster-post-herpetic neuralgia group (VZV-PHN group) and herpes zoster-control group (VZV-Con group) according to the incidence of post-herpetic neuralgia (PHN);healthy volunteers receiving physical examination in our hospital during the same period were selected as normal control group (Con group).Results: Serumβ-EP, NT, IFN-γ and IL-2 levels of VZV-PHN group and VZV-Con group were significantly lower than those of Con group (P<0.05), while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10, TGF-β1, IgG, IgM and IgA levels were significantly higher than those of Con group (P<0.05);serumβ-EP, NT, IFN-γ, IL-2, IgG, IgM and IgA levels of VZV-PHN group were significantly lower than those of VZV-Con group (P<0.05) while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1 levels were significantly higher than those of VZV-Con group (P<0.05);β-EP and NT were positively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and negatively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1;SP, VGF and CGRP were negatively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and positively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1.Conclusions:Abnormal secretion of inflammatory cytokines and immunoglobulin caused by humoral immune and cellular immune response disorder is associated with the occurrence of post-herpetic neuralgia in patients with acute herpes zoster.

高渗葡萄糖增殖疗法治疗带状疱疹后遗神经痛的效果和安全性

目的·探讨高渗葡萄糖增殖疗法(hypertonic dextrose prolotherapy,DPT)治疗带状疱疹后遗神经痛(postherpetic neuralgia,PHN)的效果和安全性。方法·选取2019年6月—2022年12月于徐州医科大学附属医院疼痛科就诊的PHN患者78例,将患者按照1∶1随机分配至对照组和研究组,每组各39例。对照组采用传统镇痛液治疗,研究组采用传统镇痛液联合DPT治疗。采用视觉模拟评分(visual analogue scale,VAS)评估患者治疗前后的疼痛程度,使用流式细胞仪测定患者T细胞亚群情况,使用酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)测定C反应蛋白(C-reactive protein,CRP)、白介素-6(interleukin-6,IL-6)及IL-10细胞因子水平。比较2组患者在治疗前,治疗后1、2、4、8及12周的VAS评分,治疗前和治疗2周后的CD4^(+)/CD8^(+)比值,CRP、IL-6、IL-10水平及不良反应发生情况。结果·2组患者的性别比例、年龄、病程差异无统计学意义。2组患者治疗后1、2、4、8及12周的疼痛评分均显著低于治疗前,差异均具有统计学意义(均P<0.05)。研究组治疗后1、2、4、8及12周的疼痛评分均显著低于对照组(均P<0.05)。2组患者治疗前CD4^(+)/CD8^(+)、CRP、IL-6及IL-10水平差异无统计学意义。治疗后研究组的IL-6、CRP水平低于对照组,差异有统计学意义(均P=0.000);治疗后研究组的CD4^(+)/CD8^(+)、IL-10水平高于对照组,差异具有统计学意义(均P=0.000)。2组患者在治疗过程中均未发生局部神经损伤、硬膜外血肿、感染、气胸、过敏等不良反应。结论·DPT可以明显缓解PHN患者疼痛,改善患者T淋巴细胞亚群和细胞因子表达,可安全应用于临床。

中国北方汉族人群PHN发病与HLA-A等位基因相关性研究

目的:探讨中国北方汉族人群中带状疱疹后神经痛(postherpetic neuralgia,PHN)的发病与人类白细胞抗原(human leukocyte antigen,HLA)的相关性。方法:收集2013年12月至2015年1月就诊于中国医科大学附属第一医院疼痛科PHN患者42例,及该院体检中心100例健康人血样,采用直接测序分型(PCR-SBT)的方法对142例样本进行HLA-A等位基因检测,并比较其分布频率及差异与PHN发病的相关性。结果:本研究中健康人群组中共检出17种HLA-A等位基因型,符合Hardy-Weinberg遗传平衡定律。PHN患者中的HLA-A*2601、-A*3004、-A*3303的基因频率明显高于健康人组(P<0.05)。而PHN患者中HLA-A*0201的基因频率明显低于健康人组(P<0.05)。结论:HLA-A*2601、-A*3004、-A*3303、-A*0201与中国北方汉族人群PHN发病相关,其中HLAA*2601、-A*3004、-A*3303为PHN发病的易感基因,而HLA-A*0201为其保护性基因。

皮肤针治疗带状疱疹后遗神经痛研究进展

带状疱疹后遗神经痛(postherpetic neuralgia,PHN)病位在皮部,主要累及肝、脾二脏,久则及肾。其发生涉及内、外两个因素,内因有年老体弱、素体亏虚、正气不足、情志内伤、饮食不节等,外因则与外感火毒湿热时邪有关。其病机有虚实两种,实为肝经湿热火毒蕴积与血气搏结,造成局部气血凝滞,经脉瘀阻不通,脏腑气机不畅则痛;虚为正气虚弱,无力抗邪,外感火毒之邪后,余邪未尽日久化火,耗伤阴血,阴血亏虚不能濡养肌肤经脉,不荣则痛。故该病治疗需要兼顾内外虚实,以扶正祛邪、理气活血、通络止痛为主。皮肤针治疗PHN可因势利导、诱邪外出,既能活血祛瘀、通络止痛,又可振奋经气、调节脏腑,常用治疗方法有:皮肤针放血、皮肤针联合普通针刺、皮肤针联合灸法、皮肤针联合中药、皮肤针联合西药等。皮肤针治疗PHN,临床叩刺部位选择主要为局部叩刺,其次是阿是穴、夹脊穴的穴位叩刺。目前,皮肤针治疗PHN的临床研究仍存在以下问题:观察的样本量较小,缺乏多中心、大样本研究;疗效评价以观察性指标为主,缺乏实验室指标观察,实验结果主观性较强,缺乏客观真实性;临床应用型研究多,基础理论型研究少;PHN易复发,病程迁延时间长,部分临床研究仅关注近期疗效,缺少后期随访;治疗主要以缓解疼痛为主,缺乏对患者的心理疏导。建议加强皮肤针治疗PHN的基础研究,注重客观疗效标准,同时注意后期随访及心理疏导,设计更为严谨的科研方案。

刃针针刺肌筋膜触发点治疗带状疱疹后神经痛40例

目的:观察刃针针刺肌筋膜触发点治疗带状疱疹后神经痛的临床疗效。方法:选取2021年10月至2022年10月上海市嘉定区南翔医院疼痛科收治的带状疱疹后神经痛患者80例,按照随机数字表法分为治疗组和对照组,每组40例。治疗组给予针刺肌筋膜触发点治疗,对照组给予普瑞巴林胶囊口服治疗。观察两组患者治疗前后视觉模拟评分(visual analogue score,VAS)、简式Mc-Gill疼痛问卷表(以下简称Mc-Gill)评分、匹兹堡睡眠质量指数量表(pittsburgh sleep quality index,PSQI)评分、炎症因子[肿瘤坏死因子(tumor necrosis factor,TNF)-α、白细胞介素(interleukin,IL)-6、IL-8]水平变化情况。结果:治疗组治疗后VAS评分、Mc-Gill评分、PSQI评分均低于对照组,差异有统计学意义(P<0.05);治疗组有效率为97.5%,对照组有效率为82.5%,治疗组有效率高于对照组,差异有统计学意义(P<0.05);治疗组治疗后TNF-α、IL-6、IL-8水平低于对照组,差异有统计学意义(P<0.05)。结论:针刺筋膜触发点治疗带状疱疹后神经痛操作简便、疗效显著,减轻患者疼痛,改善睡眠质量,降低炎症因子水平。

经骶尾关节奇神经节阻滞治疗老年会阴部PHN的效果观察

目的:观察经骶尾关节奇神经节阻滞治疗老年人会阴部带状疱疹后神经痛(PHN)的效果、安全性和并发症。方法:17例老年会阴部PHN患者经骶尾关节行奇神经节阻滞,分别于治疗前、治疗后不同时间采用视觉模拟评分(VAS)法评价患者的疼痛程度、疼痛障碍指数(PDI)评定疼痛对患者日常生活的影响、匹兹堡睡眠质量指数(PSQI)评估睡眠质量。结果:患者治疗后24h、1w、4w的VAS评分、PDI评分和PSQI评分均明显低于治疗前(P<0.01),且无不良反应发生。结论:经骶尾关节行奇神经节阻滞治疗老年PHN具有穿刺路径短、疗效确切、操作简便等优点,能显著缓解会阴部PHN所导致的疼痛。

Observation on the effect of fire needle combined with Linggui Bafa for post-herpetic neuralgia

Objective To observe the clinical effect of fire needle combined with Linggui Bafa for post-herpetic neuralgia （PHN）. Methods One hundred and twenty patients were randomly divided into an observation group and a control group with 60 cases each. For observation group, fire needle was applied to prick Zusanli （足三里 ST 36）, Yanglingquan （阳陵泉 GB 34）, Taichong （太冲 LR 3）, Sanyinjiao （三阴交 SP 6） and partial Ashi points around the lesion, and Linggui Bafa was combined to perform acupuncture therapy, once every other day, 10 times as a course of treatment; for the control group, only fire needle was applied. After 2 courses of treatment, the comparison of the value of visual analogue scale （VAS） and the total effective rate for the two groups were carried out. Results The VAS value of the observation group after treatment was obviously lower than that before treatment （2.28±2.08 vs 6.12±1.96） and that of the control group （2.28±2.08 vs 3.62±2.90）, there were significant differences （all P〈0.01）. The total effective rate of the observation group was obviously higher than that of the control group [93.3% （56/60） vs 76.7% （46/60）], the difference between the two groups was statistically significant （P〈0.05）. Conclusion The effect of fire needle combined with Linggui Ba.fa for PHN is obviously superior to that of single fire needle therapy.

Needle-embedding therapy for fifty cases of post-herpetic neuralgia

Objective To observe the clinical efficacy of needle-embedding therapy for the treatment of post-herpetic neuralgia. Method Fifty patients of post-herpetic neuralgia treated with needle-embedding therapy from January 2013 to June 2014 at Department of pain of the Second People＇s Hospital of Yibin City were selected. At each time of needle-embedding therapy, 4-8 points were selected. Patients were treated once a day, 5 times for a course of treatment and received a total of 1-3 courses of treatment. Meanwhile, the curative effect was analyzed in accordance with Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine. Result Among the 50 patients, the markedly effective rate was 84.0% （42/50）, the effective rate was 16.0% （8/50） and the total effective rate was 100.0%. Conclusion Needle-embedding therapy for the treatment of post-herpetic neuralgia offers a good curative effect.

带状疱疹后神经痛疼痛灾难化的影响因素分析

目的 探讨带状疱疹后神经痛(post-herpetic neuralgia, PHN)患者疼痛灾难化(pain catastrophizing, PC)的影响因素。方法 选取2021年9月至2022年3月及2022年6月在上海第十人民医院门诊就诊的PHN患者,通过面对面询问的方式进行问卷调查。调查内容包括人口社会量表、PC量表(pain catastrophizing scale, PCS)、数字评价量表(numerical rating scale, NRS)、健康问卷抑郁症状群量表(patient health questionnaire-9, PHQ-9)和广泛性焦虑障碍量表(generalized anxiety disorde-7, GAD-7)等。结果 246例PHN患者参与问卷调查,其中男103例(41.9%),女143例(58.1%);年龄38~88岁,平均(69.4±9.7)岁;61.8%患者合并慢性病。PCS平均得分(26.04±12.54)分,其中反刍(9.72±4.64)分,无助(11.67±6.20)分,夸大(4.60±2.53)分;57例(23.2%)PCS得分≥38分。NRS平均得分(5.71±1.51)分,112例(45.5%)PHQ-9得分≥6分,77例(31.3%)GAD-7得分≥6分。多重线性回归分析结果显示,NRS得分、动态机械性痛觉超敏、PHQ-9及GAD-7得分是PCS得分的影响因素(P <0.05),其中动态机械性痛觉超敏对PCS得分影响最大,其次是NRS和GAD-7得分,PHQ-9得分对PCS得分影响最小。结论 PHN患者PC比例较高,疼痛强度越大、有动态机械性痛觉超敏、抑郁及焦虑情绪程度越重的患者,PC水平越高,临床应尽早给予该类患者心理干预,改善患者慢性疼痛结局。

带状疱疹后遗神经痛病人中医护理研究进展

梳理带状疱疹后遗神经痛病人中医护理的研究进展,从中医病因病机、护理技术、辨证施膳、情志调摄4个方面总结带状疱疹后遗神经痛护理研究现状,旨在为开展带状疱疹后遗神经痛病人的中医护理提供参考。

T细胞免疫在针灸治疗带状疱疹及后神经痛中的研究进展

带状疱疹多发生于老年人及免疫力低下者,带状疱疹后神经痛是带状疱疹患者最常见的并发症。指南推荐的一线治疗药物对带状疱疹患者有一定缓解效果,但疗效欠满意,究其原因是其发病机制尚未明确。国内外研究显示,T细胞免疫作为免疫系统的重要组成部分,参与了带状疱疹的发生、发展。针灸治疗带状疱疹及后神经痛具有确切的临床疗效,旨在对T细胞免疫在针灸治疗带状疱疹及后神经痛中的研究进展作一综述,为后期探索针灸治疗带状疱疹潜在治疗靶点有重要意义。

Collateral-pricking and blood-letting cupping combined with electroacupuncture for post-herpetic neuralgia

Objective:To explore the clinical efficacy of collateral-pricking and blood-letting cupping combined with surrounding needling technique electroacupuncture in the treatment of post-herpetic neuralgia(PHN).Methods:Seventy-two patients with post-herpetic neuralgia were randomized into observation group and control group.Of the 72 cases,12 cases fell off,so finally 30 cases in each group.The observation group was treated with collateral-pricking and blood-letting cupping combined with surrounding needling technique electroacupuncture,while the control group was treated simply with pregabalin capsules for 20 consecutive days.On the basis of the western medication pregabalin capsules,the same as that of the control group,collateral-pricking and blood-letting cupping combined with electroacupuncture in a surrounding needling technique,was adopted for the observation group,once every two days,ten days as one course of treatment,a total of two courses.The immediate visual analogue scale(VAS)before and after treatment were observed in the two groups,and their clinical effects were compared.Results:The VAS scores of PHN patients in the two groups after treatment were lower than those before treatment(both P<0.01),and the scores of observation group were lower than those of control group(P<0.05).The total effective rate of the observation group was 86.7%,higher than 73.3% of the control group.Conclusion:The clinical effect of collateral-pricking and blood-letting cupping combined with electroacupuncture is relatively satisfactory in the treatment of post-herpetic neuralgia.

电针夹脊穴联合重复经颅磁刺激对伴情绪障碍带状疱疹后神经痛的疗效研究

目的:综合评价电针夹脊穴联合重复经颅磁刺激对伴有情绪障碍的带状疱疹后神经痛的改善作用,观察改善疼痛、情绪障碍的临床疗效。方法:随机将100例伴情绪障碍的带状疱疹后神经痛患者分为观察组、对照组,各50例。两组均采用口服营养神经药及针刺治疗,对照组加用电针阿是穴配合rTMS假刺激;观察组加用电针夹脊穴联合高低频rTMS,分别于治疗前及治疗第4、8周后采用视觉疼痛模拟评分(VAS)评定疼痛改善,汉密尔顿抑郁量表-24(HAMD-24)、汉密尔顿焦虑量表(HAMA)评定情绪改善,并评价临床疗效,治疗结束后第3个月随访疼痛情况。结果:观察组综合有效率(82.98%,39/47)优于对照组(62.5%,30/48),差异具有统计学意义;将治疗前以及治疗后的各个时间节点的改善情况进行对比,两组的VAS、HAMD-24和HAMA评分有着明显的改善(P<0.05),且对于观察组的治疗后各时间点的VAS、HAMD-24和HAMA评分情况均要优于对照组(P<0.05);疗程结束后第3个月进行回访,两组无疼痛加重。结论:电针夹脊穴联合重复经颅磁刺激,可以有效改善疼痛和情绪症状,且未来长时间内的治疗效果是稳定可靠的。

带状疱疹后神经痛临床调查分析

目的:带状疱疹后神经痛是周围神经受到病毒损伤后的疼痛疾病中最有代表性的疾病之一,本文报道疼痛科集中6年来调查、统计的临床病例结果。方法:2004年起使用神经痛表共统计门诊、住院及会诊的带状疱疹后神经痛患686例,主要观察疼痛程度和性质、临床类型、患区遗留症状和伴随症状。结果:患者主诉以自发性闪电样疼痛、刀割样疼痛、烧灼样疼痛、针刺样疼痛和混合性疼痛为多见。平均VAS评分为6.8分。患者临床表现为4种类型的变化,分别为激惹型(57.14%)、麻痹型(22.16%)、整合型(17.93%)和无激惹型(2.77%)。结论:本组疱疹后神经痛患者调查表明:大部分患者疼痛时间均超过3～6个月,最长达8年。疼痛程度为中、重度。患者的生活质量、工作能力均明显受影响。

疱疹后遗神经痛病人的神经损伤与水痘-带状疱疹病毒持续激活和复制的关系

目的 研究带状疱疹后遗神经痛 (PHN)患者的水痘 带状疱疹病毒 (VZV)持续激活、复制对感觉神经系统损伤的影响。方法 用感觉定量分析仪 (TSA 2 0 0 1)对 2 5例PHN患者和 38例带状疱疹患者的疼痛区及对侧镜像区进行感觉定量测量 ,同时用PCR和SouthernBlot方法对其外周血单核细胞 (PBMC)进行VZV检测。结果 带状疱疹急性期和PHN病人疼痛区的各感觉阈值均大于对侧镜像区 ,而愈后无PHN的带状疱疹病人两者间未见显著性差异 ;PHN病人的感觉缺失值大于带状疱疹急性期病人 ;PHN患者的VZV检出率为 32 % ,而在愈后无PHN患者却未检测到。结论 VZV在带状疱疹患者的背根神经节内长久复制和激活会引起神经系统严重的、甚至是不可逆的损伤 。

氨酚羟考酮片治疗带状疱疹后遗神经痛的临床研究

目的:探讨氨酚羟考酮片治疗带状疱疹后遗神经痛(PHN)的疗效。方法:72例PHN患者随机分为2组,治疗组36例,每次口服氨酚羟考酮片0.33 g,bid;对照组36例,每次口服布洛芬缓释胶囊,0.30 g,bid,治疗10 d后观察疗效及不良反应。结果:治疗组与对照组治疗有效率比较有显著性差异(P<0.01)。结论:氨酚羟考酮片治疗PHN安全、有效。

加巴喷丁联合用药治疗带状疱疹后神经痛伴焦虑患者的疗效观察

目的:探讨加巴喷丁(GBP)联合阿米替林、曲马多治疗带状疱疹后神经痛(PHN)伴焦虑患者的临床效果。方法:选择伴不同程度焦虑症状的PHN患者106例,随机分为观察组和对照组各53例,观察组给予GBP胶囊联合阿米替林片、曲马多缓释片;对照组单用GBP胶囊治疗,分别于用药前、用药后第1周、第4周对患者焦虑、抑郁状态,生活质量以及镇痛程度进行VAS评分,评价临床治疗效果。结果:用药第1周和第4周开始,两组焦虑状态、抑郁状态评分,生活质量以及VAS评分均较治疗前明显降低(P<0.05),且观察组评分较对照组下降更为显著(P<0.05)。观察组不良反应发生率明显低于对照组(P<0.05)。结论:GBP联合曲马多、阿米替林治疗PHN伴焦虑的患者,能有效降低患者的VAS评分,提高患者的生活质量。

加味芍药甘草汤对神经病理性疼痛伴抑郁患者的效果观察

目的 通过加味芍药甘草汤在神经病理疼痛（neuropathic pain,NP）伴抑郁患者中的应用,进一步探讨该方在带状疱疹后神经痛（postherpetic neuralgia,PHN）的治疗效果。方法 选择在浙江中医药大学第一临床医学院和丽水市中心医院疼痛门诊2015年5月-2016年5月接受治疗的PHN伴抑郁患者86例,采用随机数字表法将其分为两组,每组43例。A组采用加巴喷丁（GBP）＋阿米替林（AMI）治疗,B组采用GBP＋AMI＋加味芍药甘草汤治疗。分别记录各组用药前（T1）,用药后第1周（T2）、第2周（T3）、第3周（T4）的疼痛评分、抑郁程度评分、生活质量评分等评价指标及疼痛治疗期间的不良反应等。结果 A组患者在年龄、性别等一般资料方面与B组比较,差异无统计学意义（P〉0.05）。B组患者在GBP日均用量上显著少于A组,差异有统计学意义（P〈0.05）。在患者治疗的愈显率上比较,A组总愈显率为74.42%,明显低于B组的97.67%,差异有统计学意义（P〈0.05）。治疗后B组患者的抑郁状态、VAS评分、生活质量评分及不良反应等与A组同时点比较,差异有统计学意义（P〈0.05）。结论 加味芍药甘草汤能够舒筋缓急,活血止痛,辅西药GPB与AMI应用于PHN患者的治疗中,能有效减轻患者的疼痛,在有效抗抑郁治疗的同时,提高PHN的愈显率,改善患者的生活质量。