POST HERPETIC NEURALGIA/AMITRYPTILINE VS MORPHINE IN PATIENT MANAGEMENT

带状疱疹后神经痛/阿米替林与吗啡在患者管理中的比较

• 批准号: 6114375
• 负责人: SRINIVASA N. RAJA
• 金额: $ 2.06万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-12-01 至 1999-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6114375
• 关键词: amitriptyline; analgesia; chronic pain; clinical research; clinical trials; comorbidity; depression; drug screening /evaluation; genital herpes; human subject; human therapy evaluation; interview; medical complication; morphine; outcomes research; pain threshold; patient care management; sensory mechanism; shingles; skin hypersensitivity

The purpose of this research is to determine the effectiveness of two medications, tricyclic antitidepressants (TCA) and opioids, compared to a placebo in the treatment of postherpetic neuralgia. The specific aims are to compare the effects of opioids and TCA against placebo on pain, altered skin sensitivity, and affective and cognitive function. In addition, the study will determine if the presence of psychiatric co- morbidity, particularly depression, predicts the outcome of treatment with opioids, TCA, and placebo. We have studied the relationships between ongoing pain, alterations in thermal sensibility, and allodynia to mechanical and thermal stimuli of patients with, PHN to determine the role of peripheral and/or central mechanisms, in PHN. Ongoing pain ratings were obtained using a verbal score (0-10). Sensory tests were performed within the affected site, and the corresponding, contralateral, normal site. The area of mechanical allodynia was mapped with a cotton swab and pain, evoked by mechanical stimuli (soft hair brush, brass probe, von Frey hairs) was rated on a verbal scale of 1-10. Thermal thresholds to warm, cold, heat pain, and cold pain were determined using a Peltier device and a modified Marstock technique. To date, fifty-nine patients (33 F, 26 M) with PHN of 3-216 months duration (median = 19 months) have been studied. The average rating of ongoing pain was 7.3 + 2 (M + SD). The majority of patients (80%) had allodynia to dynamic (hair brush), static (brass probe) or punctate (von Frey) mechanical stimuli (Z > 5.01, p<.0001). No significant correlation was observed between the intensity of ongoing pain and mechanical allodynia. As a group, the patients demonstrated hypoesthesia to cold and warm detection, and hypoalgesia to heat pain and cold pain. There were no significant correlations between ongoing pain intensity and the degree of sensory alterations (between the unaffected and affected sites) in warm, cold, heat pain, and cold pain detection thresholds. Hence, the role of primary afferent input in tlie mechanism of PHN is uncertain. The presence of allodynia/hyperalgesia to mechanical stimuli, but the relative absence of hyperalgesia to thermal stimuli in most patients in this group suggests that central sensitization in PHN is not generalized for all modalities of sensation. It has been observed that patients with chronic pain have high rates of psychiatric conditions. Controversy has existed as to whether these conditions are uniquely related to chronic pain or simply the result of ongoing suffering from a chronic physical symptom. Patients completed a structured interview (DIS-III-A) for Major Depression, Dysthymic Disorder, Generalized Anxiety Disorder and Somatization Disorder and completed the Somatization and Anxiety subscales of the SCL-90-R. Our results in PHN patients are consistent with the existing literature. PHN patients compared to patients with chronic and distressing but non- pain physical symptoms also reported higher numbers of depression symptoms as well as other medically unexplained physical symptoms. These findings suggest that depression and higher levels of somatic focus are more than secondary complications of experiencing chronic symptoms and are uniquely related to chronic pain.

这项研究的目的是确定两个 相比 安慰剂治疗后的螺旋神经痛。 具体目标 是要比较阿片类药物和TCA与安慰剂对疼痛的影响， 皮肤灵敏度改变，情感和认知功能。 在 此外，该研究还将确定精神病的存在是否存在 发病率，尤其是抑郁症，可以预测治疗的结果 与阿片类药物，TCA和安慰剂。 我们研究了持续疼痛，改变之间的关系 热敏感性以及对机械和热刺激的异常性敏感性 PHN患者确定外围和/或中央的作用 机制，in Phn。 使用语言获得了持续的疼痛等级 得分（0-10）。 在受影响的站点内进行感觉测试， 以及相应的对侧，正常位点。 面积 机械性异常性ni症用棉签和疼痛映射，引起 机械刺激（软毛刷，黄铜探针，冯·弗雷头发）是 以1-10的口头量表进行评分。 热阈值温暖，冷， 热疼痛和冷疼痛是使用毛发器装置和A确定的 修改后的马斯托克技术。 迄今为止，PHN为3-216个月的五十九名患者（33 F，26 m） 持续时间（中位数= 19个月）已被研究。 平均评分 持续的疼痛为7.3 + 2（M + SD）。 大多数患者（80％）有 异常动态（毛刷），静态（黄铜探针）或点状（von） Frey）机械刺激（z> 5.01，p <.0001）。 没有意义 观察到持续疼痛的强度和 机械性异常。 作为一个小组，患者证明了 寒冷和温暖的检测缺乏症，以及痛苦疼痛的低变性 和冷痛。 正在进行之间没有显着相关性 疼痛强度和感觉改变程度（在 不受影响和受影响的地点）在温暖，寒冷，热痛和寒冷的疼痛中 检测阈值。 因此，主要传入输入在tlie中的作用 PHN机制尚不确定。 异常痛/痛觉过敏的存在 进行机械刺激，但相对缺乏痛觉过敏 该组大多数患者的热刺激表明中央 PHN中的灵敏度并未以所有感觉方式概括。 已经观察到患有慢性疼痛的患者的发生率很高 精神病。 关于这些是否存在争议 疾病与慢性疼痛或仅仅是独特的 持续患有慢性身体症状。 患者完成了 大抑郁症，心脏病障碍的结构化访谈（DIS-III-A） 障碍，广义焦虑症和躯体化障碍以及 完成了SCL-90-R的躯体化和焦虑量表。 我们的 PHN患者的结果与现有文献一致。 PHN患者与患有慢性和痛苦但非 - 的患者相比 疼痛的身体症状也报告了抑郁症的数量更高 症状以及其他医学上无法解释的身体症状。这些 调查结果表明，抑郁症和较高水平的躯体重点是 经历慢性症状和 与慢性疼痛独特有关。