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.

本研究的目的是确定两种方法的有效性 药物、三环类抗抑郁药 (TCA) 和阿片类药物相比 治疗带状疱疹后神经痛的安慰剂。 具体目标 比较阿片类药物和 TCA 与安慰剂对疼痛的影响， 改变皮肤敏感性以及情感和认知功能。 在 此外，该研究将确定是否存在精神疾病 发病率，特别是抑郁症，可以预测治疗结果 阿片类药物、TCA 和安慰剂。 我们研究了持续的疼痛与变化之间的关系 热敏感性，以及对机械和热刺激的异常性疼痛 PHN 患者，以确定外周和/或中枢的作用 机制，在 PHN 中。 持续的疼痛评级是通过口头方式获得的 得分（0-10）。 在受影响的部位进行感官测试， 以及相应的对侧正常部位。 面积为 机械性异常性疼痛用棉签绘制，疼痛由以下因素引起 机械刺激（软毛刷、黄铜探针、冯弗雷毛） 按 1-10 分的语言等级进行评分。 热阈值、冷阈值、 使用 Peltier 装置和 改良的马斯托克技术。 迄今为止，59 名患者（33 F，26 M）的 PHN 为 3-216 个月 持续时间（中位 = 19 个月）已被研究。 平均评分为 持续疼痛为 7.3 + 2 (M + SD)。 大多数患者（80%）患有 动态（毛刷）、静态（黄铜探头）或点状（冯 Frey）机械刺激（Z > 5.01，p<.0001）。 无显着性 观察到持续疼痛的强度和 机械性异常性疼痛。 作为一个群体，患者表现出 对冷热感觉感觉减退，对热痛感觉减退 和冷痛。 正在进行的之间不存在显着相关性 疼痛强度和感觉改变的程度（在 未受影响的部位和受影响的部位）有热痛、冷痛、热痛和冷痛 检测阈值。 因此，初级传入输入在这方面的作用 PHN 的发病机制尚不明确。 存在异常性疼痛/痛觉过敏 机械刺激，但相对缺乏痛觉过敏 本组大多数患者的热刺激表明中枢 PHN 的敏化并不适用于所有感觉方式。 据观察，慢性疼痛患者的发病率很高。 精神状况。 对于这些是否有效存在争议 这些病症与慢性疼痛独特相关，或者仅仅是以下原因的结果 持续患有慢性身体症状。 患者完成 针对重度抑郁症、心境恶劣的结构化访谈 (DIS-III-A) 障碍、广泛性焦虑症和躯体化障碍以及 完成了 SCL-90-R 的躯体化和焦虑分量表。 我们的 PHN 患者的结果与现有文献一致。 PHN 患者与慢性且令人痛苦但非 疼痛的身体症状也报告了更多的抑郁症患者 症状以及其他医学上无法解释的身体症状。这些 研究结果表明，抑郁症和更高水平的躯体注意力 不仅仅是经历慢性症状的继发并发症和 与慢性疼痛有独特的关系。