POST HERPETIC NEURALGIA/AMITRYPTILINE VS MORPHINE IN PATIENT MANAGEMENT

本研究的目的是确定两种药物的有效性，三环抗抑郁药（TCA）和阿片类药物，比较安慰剂在治疗疱疹后神经痛。具体目的是比较阿片类药物和TCA与安慰剂对疼痛、皮肤敏感性改变、情感和认知功能的影响。此外，该研究将确定阿片类药物或TCA治疗是否会影响认知功能，这可能会限制它们在治疗PHN中的有效性。我们研究了PHN患者对机械和热刺激的持续疼痛、热敏感性改变和异常性疼痛之间的关系，以确定外周和/或中枢机制在PHN中的作用。使用口头评分（0-10）获得持续疼痛评分。在受影响的部位和相应的对侧正常部位进行感觉测试。用棉签绘制机械异常性疼痛区域，并对机械刺激（软毛刷、黄铜探针、von Frey毛）引起的疼痛进行口头评分，评分范围为0-10分。使用Peltier装置和改良的Marstock技术确定热痛、冷痛、热痛和冷痛的热阈值。认知功能测试包括数字符号测试、数字跨度测试、数字消去测试、凹槽钉板测试和语言学习测试。

The purpose of this research is to determine the effectiveness of two medications, tricyclic antidepressants (TCA) and opioids, compared to a placebo in the treatment of Post-Herpetic 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 therapy with opioids or TCA affects cognitive function that may limit their usefulness in the treatment of PHN. 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 0-10. Thermal thresholds to warm, cold, heat pain, and cold pain were determined using a Peltier device and a modified Marstock technique. Measures of cognitive function included the Digit symbol test, Digit Span, a digit cancellation test, the grooved pegboard, and a measure of verbal learning.