The Sympathetic Nervous System in Post-Herpetic Neuralgia
The Sympathetic Nervous System in Post-Herpetic Neuralgia
复制标题
带状疱疹后神经痛的交感神经系统
DOI：
10.1136/rapm-00115550-199318050-00001
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发表时间：
1993
影响因子：
5.1
通讯作者：
Q. Hogan
中科院分区：
文献类型：
--
作者：
Q. Hogan
271例带状疱疹后神经痛（PHN）。通常有一种强烈的，燃烧的，表面的疼痛，扰乱睡眠和日常生活的活动。急性带状疱疹康复患者的病理学检查显示，DRG、感觉根和背角的细胞丢失和脱髓鞘，这可能是治疗后神经痛患者所特有的，并且大的有髓鞘纤维优先破坏，表明中枢感觉处理异常。这些是基于几个主题的初步调查结果。当病理生理学未知时，医疗决策可以由精算数据指导。也就是说，即使我们不知道一种疾病或一种疗法是如何工作的，如果我们能够根据临床研究认识到应该使用什么疗法以及在哪些患者中使用它们，我们就可以提供良好的护理。这就是结果分析的本质。为此，温妮和哈特韦尔在本期的一份报告中评估了交感神经阻滞治疗PHN的有效性和时机。结果令人鼓舞，值得密切关注。PHN的发病率通常定义为持续超过急性期4 - 6周的疼痛，其强烈依赖于年龄，老年人的发病率为30-50%，而总体发病率约为5-10%。5-7为了确定在温妮和哈特韦尔的研究中，各组中接受治疗的患者具有可比性，应检查各组的年龄分布。更麻烦的是缺乏一个对照组。温妮和哈特韦尔发现，在PHN病程早期接受治疗的患者更有可能康复。是
271 post-herpetic neuralgia (PHN). There is typically an intense, burning, superficial pain that disrupts sleep and the activities of daily life. º Pathologic examinations of patients who have recovered from acute zoster reveal cell loss and demyelination in the DRG, sensory root, and dorsal horn that may be unique to those patients with posttherapeutic neuralgia, and a preferential destruction of large myelinated fibers, suggesting aberrant central sensory processing.* These are preliminary findings based upon a few subjects. When the pathophysiology is not known, medical decisions may be guided by actuarial data. That is, even though we don't know how a disease or a therapy works, we can provide good care if we can recognize what therapy to use and in which patients to use them, based on clinical studies. This is the essence of outcome analysis. To this end, a report in this issue by Winnie and Hartwellº evaluates the usefulness and timing of sympathetic blockade for the treatment of PHN. The results are promising and deserve close attention. How-ever, certain limitations should be noted.The incidence of PHN, typically defined as pain that lasts beyond the 4 to 6 weeks of the acute phase, is strongly dependent upon age, with an incidence of 30–50% in the aged compared to about 5–10% overall. 5-7 To be certain that comparable patients were being treated in the various groups in the study of Winnie and Hartwell, the age distribution in each group should have been examined. More troublesome is the lack of a control group. Winnie and Hartwell found that recovery was more likely in patients treated early in the course of PHN. Is