TRICYCLIC ANTIDEPRESSANTS AND OPIOIDS IN POSTHERPETIC NEURALGIA 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。 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 PHN中的机制。 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绘制的， 机械刺激（软毛刷，黄铜探针，von Frey头发）， 用0-10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，32例PHN 3-216个月的患者（19例F，13例M） 持续时间（M= 39 m）进行了研究。 持续疼痛的平均评分 为7.1 ± 2（M ± SD）。 大多数患者 (23/32）对动态（毛刷）、静态（黄铜探针）或 点状（von Frey）机械刺激（Z等于或大于 3.82，p等于或小于.0001）。 无显著相关性 观察持续疼痛和机械性异常性疼痛的强度之间的关系。 大多数患者（22/32）热痛阈值升高，即： 痛觉减退（比对照组高3.4 ± 2.8oC）， 存在机械性异常性疼痛。 持续疼痛的严重程度为 与热痛阈值的缺陷正相关（r= 0.39， p=.028）。 因此，初级传入输入的作用机制， PHN不确定。 机械性痛觉超敏的存在 刺激，但缺乏痛觉过敏的热刺激，在大多数 本组患者提示PHN的中枢致敏作用不是 普遍适用于所有的感觉方式。 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。 结果 表明PHN患者的抑郁率很高， 现有的文学。 PHN患者与慢性 令人痛苦但非疼痛的身体症状也报告较高 抑郁症状以及其他医学上无法解释的 身体症状。

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 postherpetic neuralgia. The specific aims are to compare the effects of opioids and TCA against placebo on pain, altered skin sensitivity, 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 opiods, 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 0-10. Thermal thresholds to warm, cold, heat pain, and cold pain were determined using a Peltier device and a modified Marstock technique. To date, thirty-two patients (19F, 13M) with PHN of 3-216 months duration (M=39m) have been studied. The average rating of ongoing pain was 7.1 plus or minus 2(M plus or minus SD). The majority of patients (23/32) had allodynia to dynamic (hair brush), statis ( brass probe) or punctate (von Frey) mechanical stimuli (Z equal to or greater than 3.82, p equal to or less than .0001). No significant correlaation was observed between the intensity of ongoing pain and mechanical allodynia. Most patients (22/32) had an increase in heat pain threshold, i.e. hypalgesia (3.4 plus or minus 2.8oC greater than control) despite the presence of mechanical allodynia. The severity of ongoing pain was positively correlated with deficits in heat pain thresholds (r=.39, p=.028). Hence, the role of primary afferent input in the mechanism of PHN is uncertain. The presence of allodynia/hyperalgesia to mechanical stimuli, but the 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. The results demonstrate a high rate of depression in PHN patients 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.