RELIEF OF POSTHERPETIC NEURALGIA WITH THE N-METHYL-D-ASPARTIC ACID RECEPTOR ANTAGONIST KETAMINE - A DOUBLE-BLIND, CROSS-OVER COMPARISON WITH MORPHINE AND PLACEBO
RELIEF OF POSTHERPETIC NEURALGIA WITH THE N-METHYL-D-ASPARTIC ACID RECEPTOR ANTAGONIST KETAMINE - A DOUBLE-BLIND, CROSS-OVER COMPARISON WITH MORPHINE AND PLACEBO
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DOI：
10.1016/0304-3959(94)90129-5
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发表时间：
1994-09-01
期刊：
影响因子：
7.4
通讯作者：
BREIVIK, H
中科院分区：
文献类型：
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作者：
EIDE, PK;JORUM, E;BREIVIK, H
观察8例带状疱疹后神经痛患者静脉注射氯胺酮(0.15 mg/kg)、吗啡(0.075 mg/kg)或生理盐水前后的痛觉阈值变化。采用随机、双盲、交叉研究设计。带状疱疹后神经痛与感觉功能受损有关，表现为与对侧未受影响的皮肤区相比，患侧的触觉和温暖感觉减少。氯胺酮和吗啡都不会显著改变热、冷、热、痛或触觉的阈值。然而，氯胺酮使4名患者的异常热痛感恢复正常，可能是由于中枢作用。氯胺酮，而不是吗啡，产生了显著的止痛效果。氯胺酮和吗啡对皮肤非伤害性刺激引起的疼痛(痛觉异常)均有显著抑制作用。氯胺酮显著抑制绞痛样疼痛(即反复刺痛受影响的皮肤区域引起的疼痛)，但吗啡显著加重。8例患者注射氯胺酮后均出现副作用，6例注射吗啡后出现不良反应。目前的结果支持N-甲基-D-天冬氨酸(NMDA)受体参与控制带状疱疹后神经痛的假说，包括痛觉过敏和发条样疼痛。NMDA受体也可能在热感觉的调节中发挥作用。
Pain and sensory thresholds were examined before and after intravenous administration of ketamine (0.15 mg/kg), morphine (0.075 mg/kg) or saline in 8 patients with post-herpetic neuralgia. A randomized, double-blind, cross-over study design was used. Post-herpetic neuralgia was associated with impaired sensory function, as shown by reduced tactile and warm sensation in the affected compared with the contralateral non-affected skin area. Neither ketamine nor morphine changed significantly the thresholds for warm, cold, heat pain or tactile sensation. However, ketamine normalized abnormal heat pain sensations in 4 patients, probably due to a central effect. Ketamine, but not morphine, produced significant relief of pain. Pain evoked by non-noxious stimulation of the skin (allodynia) was significantly inhibited by ketamine as well as by morphine. Wind-up-like pain (i.e., pain evoked by repeatedly pricking the affected skin area) was significantly inhibited by ketamine, but significantly aggravated by morphine. Side effects were observed in all the 8 patients after injection of ketamine and in 6 patients after injection of morphine. The present results support the hypothesis that the N-methyl-D-aspartic acid (NMDA) receptors are involved in the control of post-herpetic neuralgia including allodynia and wind-up-like pain. The NMDA receptors also may play a role in the modulation of thermal perception.