Course of herpes zoster-associated pain.

在一些患者中，即使在使用小剂量局麻药的连续硬膜外阻滞期间，带状疱疹相关疼痛也会复发。在223例连续硬膜外阻滞患者中，29例发生了并发症。年龄和疼痛复发之间没有关系。轻度皮肤病变患者中无1例，中度皮肤病变93例中有5例，重度皮肤病变96例中有24例。疼痛复发的平均天数为皮肤病变发作后15天。中度和重度皮肤病变患者中未观察到显著差异。带状疱疹疼痛复发患者的带状疱疹相关疼痛持续时间明显长于无复发患者，建议使用阿米替林预防急性带状疱疹疼痛进展为带状疱疹后神经痛。19例患者在皮损发生后7天内开始使用阿米替林10 mg，并逐渐增加剂量。该剂量被硝化以减轻疼痛，没有明显的副作用。15例患者接受了除阿米替林以外的相同方案治疗。所有患者均采用连续硬膜外阻滞、口服阿昔洛韦4g/d或伐昔洛韦3g/d、可待因和对乙酰氨基酚治疗。平均年龄（± SD）服用阿米替林组平均寿命为56.7±19.5岁，未服用阿米替林组平均寿命为36.7±27.7岁。在中度皮肤损害的患者中，急性疱疹性疼痛的平均持续时间（定义为从疼痛发作到硬膜外阻滞停止的天数）在服用阿米替林的患者中为20.0天，在未服用阿米替林的患者中为18.2天。在严重皮肤损害的患者中，服用阿米替林的患者为25.1天，未服用阿米替林的患者为22.9天。在我们的患者中，早期用阿米替林治疗急性疱疹性疼痛并不能缩短带状疱疹相关疼痛的持续时间。

Zoster-associated pain'recurs even during continuous epidural block using a small dose of local anesthetics in some patients. It occurred in 29 patients among 223 inpatients who were treated with continuous epidural block. There was no relation between age and recurrence of pain. It was noted in no patients with mild skin lesions, in 5 of 93 with moderate skin lesions, and in 24 of 96 with severe skin lesions. Mean days of recurrence of pain was 15 days after the onset of skin lesions. No significant difference was observed in patients between moderate and severe skin lesions. The duration of zoster-associated pain was significantly longer in patients with recurrence of pain as compared with that of those without recurrence of pain, Amitriptyline is recommended to prevent the progression of acute herpetic pain into postherpetic neuralgia. Amitriptyline 10 mg was begun and gradually increased in 19 patients who were treated within 7 days after the onset of skin lesions. The dose was nitrated to relieve pain without significant side-effects. Fifteen patients were treated with the same regimen other than amitriptyline. All were treated with continuous epidural block, oral acyclovir 4 g/day or valacycloyir 3 g/day, codeine and acetaminophen. The mean age (±S.D.) of patients who took amitriptyline was 56.7±19.5 years, and it was 36.7±27.7 years in those who did not take amitriptyline. In patients with moderate skin lesions, the mean duration of acute herpetic pain, which was defined as the days from the onset of pain to cessation of epidural block, was 20.0 days in those who took amitriptyline and it was 18.2 days in those who did not take amitriptyline. In patients with severe skin lesions, it was 25.1 days in those who took amitriptyline and it was 22.9 days in those who did not take amitriptyline. In our patients, early treatment with amitriptyline of acute herpetic pain did not shorten the duration of zoster-associated pain.