Progress on the pathogenesis and diagnosis and treatment of postherpetic neuralgia

doi:10.3877/cma.j.issn.2095-655X.2024.03.011

Abstract

Abstract:

Herpes zoster is a skin infection caused by reactivation of the latent varicella-zoster virus in the cranial ganglia and dorsal root ganglia of the spinal cord. Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster. It occurs in the elderly and immunosuppressed patients, and seriously affects the patients′ work and quality of life due to its refractory nature. In the past, most of the studies on PHN focused on clinical research and therapeutic strategies, but less on its specific pathogenesis. This article summarizes the current status and progress of clinical research on PHN in its pathogenesis, risk factors, prognosis, and preventive and curative measures, aiming to provide a reference for clinical prevention and treatment of PHN.

Key words: Neuralgia, postherpetic, Pathogenesis, Symptom assessment, Therapeutic

Ruonan Li, Jin Song, Yuzhong Wang. Progress on the pathogenesis and diagnosis and treatment of postherpetic neuralgia[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(03): 199-205.

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References 64

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药物	剂量(成人)	不良反应	注意事项
局部治疗
利多卡因贴片	5.0%；每日最多使用3贴	局部红斑、皮疹	避免对酰胺局部麻醉剂过敏的患者
辣椒素乳膏	0.075%；每日4次	红斑、皮疹、用药局部刺痛感	避免接触眼睛和黏膜
辣椒素贴片	8.0%；贴于患处持续30～90 min	红斑、皮疹、用药局部刺痛感	避免接触眼睛和黏膜；由临床医生每3个月进行1次用药
全身治疗
加巴喷丁	在给药第1天可采用300 mg/次qd；第2天为300 mg/次bid；第3天为300 mg/次tid。随后可根据疼痛的需要逐渐增加剂量至每日1 800 mg，分3次服用	嗜睡、头晕、疲劳、复视、感觉异常、水肿、体重增加	禁用于加巴喷丁过敏者及急性胰腺炎患者；慎用于肾功能不全患者
普瑞巴林	起始剂量可为75 mg/次bid；1周内根据疗效及耐受性增加至150 mg/次bid；2～4周后仍未缓解且耐受本品者增加至300 mg/次bid；最大剂量为每天600 mg	同加巴喷丁	同加巴喷丁
阿米替林	睡前口服10～25 mg初始剂量，然后每周增加10～25 mg，达到75～150 mg/d的目标剂量	视力模糊、便秘，口干、嗜睡、尿潴留、体重增加	停止治疗时应逐渐减少剂量；慎用于老年人；禁用于患有心律不齐、青光眼、癫痫发作或自杀风险的患者；避免同时使用曲马多、选择性5-羟色胺再摄取抑制剂和5-羟色胺-去甲肾上腺素再摄取抑制剂(5-羟色胺综合征的风险)

药物	剂量(成人)	不良反应	注意事项
局部治疗
利多卡因贴片	5.0%；每日最多使用3贴	局部红斑、皮疹	避免对酰胺局部麻醉剂过敏的患者
辣椒素乳膏	0.075%；每日4次	红斑、皮疹、用药局部刺痛感	避免接触眼睛和黏膜
辣椒素贴片	8.0%；贴于患处持续30～90 min	红斑、皮疹、用药局部刺痛感	避免接触眼睛和黏膜；由临床医生每3个月进行1次用药
全身治疗
加巴喷丁	在给药第1天可采用300 mg/次qd；第2天为300 mg/次bid；第3天为300 mg/次tid。随后可根据疼痛的需要逐渐增加剂量至每日1 800 mg，分3次服用	嗜睡、头晕、疲劳、复视、感觉异常、水肿、体重增加	禁用于加巴喷丁过敏者及急性胰腺炎患者；慎用于肾功能不全患者
普瑞巴林	起始剂量可为75 mg/次bid；1周内根据疗效及耐受性增加至150 mg/次bid；2～4周后仍未缓解且耐受本品者增加至300 mg/次bid；最大剂量为每天600 mg	同加巴喷丁	同加巴喷丁
阿米替林	睡前口服10～25 mg初始剂量，然后每周增加10～25 mg，达到75～150 mg/d的目标剂量	视力模糊、便秘，口干、嗜睡、尿潴留、体重增加	停止治疗时应逐渐减少剂量；慎用于老年人；禁用于患有心律不齐、青光眼、癫痫发作或自杀风险的患者；避免同时使用曲马多、选择性5-羟色胺再摄取抑制剂和5-羟色胺-去甲肾上腺素再摄取抑制剂(5-羟色胺综合征的风险)

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