Intravenous patient-controlled analgesia hydromorphone combined with pregabalin for the treatment of postherpetic neuralgia: a multicenter, randomized controlled study
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Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.
Abstract
Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.
참고문헌 (16)
- Tsai CC, "Effect of the herbal drug guilu erxian jiao on muscle strength, articular pain, and disability in elderly men with knee osteoarthritis", Evid Based Complement Alternat Med, 2014, pp.297458~ (2014)
- Watson CP, "A new treatment for postherpetic neuralgia", N Engl J Med, 343, pp.1563~1565 (2000)
- Schmader KE, "Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy", Clin J Pain, 18, pp.350~354 (2002)
- Johnson RW, "Treatment of herpes zoster and postherpetic neuralgia", BMJ, 326, pp.748~750 (2003)
- Johnson RW, "The impact of herpes zoster and postherpetic neuralgia on quality-of-life", BMC Med, 8, pp.37~ (2010)
- Gnann JW Jr, "Clinical practice. Herpes zoster", N Engl J Med, 347, pp.340~346 (2002)
- Hansson PT, "Pharmacological treatment of peripheral neuropathic pain conditions based on shared commonalities despite multiple etiologies", Pain, 113, pp.251~254 (2005)
- Baron R, "Prevention and treatment of postherpetic neuralgia", Lancet, 367, pp.186~188 (2006)
- Quigley C, "Hydromorphone for acute and chronic pain", Cochrane Database Syst Rev, 1, pp.CD003447~ (2002)
- Sarhill N, "Hydromorphone : pharmacology and clinical applications in cancer patients", Support Care Cancer, 9, pp.84~96 (2001)
- Mahler DL, "Relative analgesic potencies of morphine and hydromorphone in postoperative pain", Anesthesiology, 42, pp.602~607 (1975)
- Dworkin RH, "Pharmacologic management of neuropathic pain : evidence-based recommendations", Pain, 132, pp.237~251 (2007)
- Rauck RL, "Once-daily gastroretentive gabapentin for postherpetic neuralgia : integrated efficacy, time to onset of pain relief and safety analyses of data from two phase 3, multicenter, randomized, double-blind, placebo-controlled studies", J Pain Symptom Manage, 46, pp.219~228 (2013)
- Melzack R, "The short-form McGill Pain Questionnaire", Pain, 30, pp.191~197 (1987)
- Raskind MA, "Trial of prazosin for post-traumatic stress disorder in military veterans", N Engl J Med, 378, pp.507~517 (2018)
- Chang AK, "Randomized clinical trial of the 2 mg hydromorphone bolus protocol versus the “1+1” hydromorphone titration protocol in treatment of acute, severe pain in the first hour of emergency department presentation", Ann Emerg Med, 62, pp.304~310 (2013)