POST HERPETIC NEURALGIA/AMITRYPTILINE VS MORPHINE IN PATIENT MANAGEMENT

本研究的目的是确定两个有效性 药物，三环类抗抑郁药（TCA）和阿片类药物， 治疗带状疱疹后神经痛的安慰剂。 具体目标 是比较阿片类药物和TCA与安慰剂对疼痛的影响， 改变皮肤敏感性以及情感和认知功能。 在 此外，该研究将确定是否存在精神病共 发病率，特别是抑郁症，预测治疗的结果 阿片类药物三氯乙酸和安慰剂 我们已经研究了持续性疼痛， 热敏感性和对机械和热刺激的异常性疼痛， PHN患者，以确定外周和/或中枢 机制，在PHN。 使用口头评估获得持续疼痛评级。 评分（0-10）。 在受影响的部位进行感官测试， 和相应的对侧正常部位 领域 机械性异常性疼痛是用棉签和疼痛，诱发的 机械刺激（软毛刷，黄铜探针，von Frey头发）， 用1-10分的语言评分 热阈值，温暖，寒冷， 热痛和冷痛使用Peltier装置和 改良Marstock技术。 迄今为止，59例PHN 3-216个月的患者（33例F，26例M） 持续时间（中位数= 19个月）进行了研究。 平均评分 持续疼痛为7.3 ± 2（M + SD）。 大多数患者（80%） 动态（毛刷）、静态（黄铜探针）或点状（血管）异常性疼痛 Frey）机械刺激（Z > 5.01，p<.0001）。 无显著 观察到持续疼痛强度与 机械性异常性疼痛 作为一个群体，患者表现出 对冷、温探测的感觉减退，对热痛的痛觉减退 寒冷的疼痛。 正在进行的研究中， 疼痛强度和感觉改变的程度（ 未受影响的和受影响的部位），在温暖，寒冷，热痛和冷痛 检测阈值 因此，初级传入输入的作用， PHN的机制尚不确定。 存在异常性疼痛/痛觉过敏 机械刺激，但相对缺乏痛觉过敏， 该组中大多数患者的热刺激表明， PHN中的致敏并不普遍适用于所有感觉形式。 已经观察到，患有慢性疼痛的患者具有高的疼痛发生率。 精神状况 争议在于， 条件是唯一相关的慢性疼痛或简单的结果， 持续遭受慢性身体症状的折磨。 患者完成 结构化访谈（DIS-III-A） 广泛性焦虑症和躯体化障碍， 完成SCL-90-R的躯体化和焦虑分量表。 我们 PHN患者的结果与现有文献一致。 PHN患者与慢性和痛苦但非慢性PHN患者相比， 疼痛的身体症状也报告了更多的抑郁症 症状以及其他医学上无法解释的身体症状。这些 研究结果表明，抑郁症和更高水平的躯体关注是 超过经历慢性症状的继发性并发症， 与慢性疼痛有着独特的联系

The purpose of this research is to determine the effectiveness of two medications, tricyclic antitidepressants (TCA) and opioids, compared to a placebo in the treatment of postherpetic 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 presence of psychiatric co- morbidity, particularly depression, predicts the outcome of treatment with opioids, TCA, and placebo. 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 1-10. Thermal thresholds to warm, cold, heat pain, and cold pain were determined using a Peltier device and a modified Marstock technique. To date, fifty-nine patients (33 F, 26 M) with PHN of 3-216 months duration (median = 19 months) have been studied. The average rating of ongoing pain was 7.3 + 2 (M + SD). The majority of patients (80%) had allodynia to dynamic (hair brush), static (brass probe) or punctate (von Frey) mechanical stimuli (Z > 5.01, p<.0001). No significant correlation was observed between the intensity of ongoing pain and mechanical allodynia. As a group, the patients demonstrated hypoesthesia to cold and warm detection, and hypoalgesia to heat pain and cold pain. There were no significant correlations between ongoing pain intensity and the degree of sensory alterations (between the unaffected and affected sites) in warm, cold, heat pain, and cold pain detection thresholds. Hence, the role of primary afferent input in tlie mechanism of PHN is uncertain. The presence of allodynia/hyperalgesia to mechanical stimuli, but the relative absence of hyperalgesia to thermal stimuli in most patients in this group suggests that central sensitization in PHN is not generalized for all modalities of sensation. It has been observed that patients with chronic pain have high rates of psychiatric conditions. Controversy has existed as to whether these conditions are uniquely related to chronic pain or simply the result of ongoing suffering from a chronic physical symptom. Patients completed a structured interview (DIS-III-A) for Major Depression, Dysthymic Disorder, Generalized Anxiety Disorder and Somatization Disorder and completed the Somatization and Anxiety subscales of the SCL-90-R. Our results in PHN patients are consistent with the existing literature. PHN patients compared to patients with chronic and distressing but non- pain physical symptoms also reported higher numbers of depression symptoms as well as other medically unexplained physical symptoms. These findings suggest that depression and higher levels of somatic focus are more than secondary complications of experiencing chronic symptoms and are uniquely related to chronic pain.