Vpliv pregabalina na akutno zostrno nevralgijo

Krčevski Škvarč, Nevenka

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Title:	Vpliv pregabalina na akutno zostrno nevralgijo
Authors:	ID Krčevski Škvarč, Nevenka (Author) ID Kamenik, Mirt (Mentor) More about this mentor... ID Drinovec, Jože (Comentor)
Files:	DR_Krcevski_Skvarc_Nevenka_2013.pdf (1,50 MB) MD5: 21103E8A3A1572C557F2159FD5C1F6E6 PID: 20.500.12556/dkum/ee21a927-aaa5-41a8-bb90-b0063ce4854f
Language:	Slovenian
Work type:	Dissertation
Organization:	MF - Faculty of Medicine
Abstract:	Akutna zostrna nevralgija se pojavi ob izbruhu herpetičnega izpuščaja. Ima specifično kakovost bolečine, ki je združena s pojavi hiperalgezije in alodinije, občutenja pekočine, zbadanja, mravljinčenja in sunkovitega sekanja. Običajno izzveni hkrati z izginotjem izpuščaja. Bolečina je lahko huda, traja tudi dlje časa ali celo preide v kronično bolezen. Postzostrna nevralgija je kronična nevropatična bolečina, ki je zelo slabo odzivna na zdravljenje. Bolnikom pomembno zmanjšuje kakovost življenja. Zato so zelo pomembna vsa prizadevanja za učinkovito lajšanje akutne bolečine in preprečitev postzostrne nevralgije. V raziskavi smo proučevali učinek pregabalina v lajšanju akutne zostrne nevralgije in preprečevanju nastanka postzostrne nevralgije. Bolniki in metode Tritedenska klinična primerjalna raziskava je bila zasnovana kot prospektivna randomizirana dvojno slepa v primerjavi s placebom. Vanjo smo vključili bolnike, ki so med sedmim in štirinajstim dnevom poteka zostrne bolezni imeli močnejšo bolečino ocenjeno s 4 in več po enajsttočkovni Likertovi lestvici. V treh tednih smo jih v prvi skupini zdravili s pregabalinom po 150 do 300 mg na dan, v drugi pa s placebom. Če so potrebovali, so protibolečinsko lahko dodatno vzeli še naproksen, tramadol ali oksikodon. V času zdravljenja smo ocenjevali bolečino, alodinijo, hiperalgezijo, občutenje pekočine, zbadanje, sunkovite bolečine, kakovost spanja in omejenost telesne dejavnosti. Beležili smo dodatno porabo analgetikov in pojav neželenih učinkov. Po treh tednih zdravljenja smo opredelili pojav subakutne zostrne nevralgije. Bolnike smo dodatno po šestih mesecih znova poklicali po telefonu, da bi ugotovili in opredelili pojav postzostrne nevralgije. Rezultati V raziskavi je sodelovalo 38 bolnikov, 20 jih je bilo v skupini s pregabalinom in 18 v skupini s placebom. Med bolniki ni bilo statistično značilnih razlik glede na starost, spol, višino, težo, dermatomsko prizadetost z izpuščajem, uporabo protivirusnih zdravil, niti po trajanju akutne zostrne bolečine in dolžini raziskave. Med skupino bolnikov zdravljenih s pregabalinom in skupino, ki je uporabljala placebo, s standardno statistično analizo nismo ugotovili statistično značilnih razlik v jakosti bolečine, alodinije, hiperalgezije, občutenju pekočine, zbadanja, mravljinčenja, sunkovite bolečine, niti v kakovosti spanja in omejitvi telesne dejavnosti. V skupini s pregabalinom (15 mg  12 mg) smo ugotovili statistično značilno manjšo povprečno dnevno porabo analgetikov v ekvivalentu morfina kot v primerjavi s placebno skupino bolnikov (26 mg  12 mg). Med skupinama nismo ugotovili statistično značilne razlike pri pojavu neželenih učinkov ali subakutne in postzostrne nevralgije. V odstotkovnem prikazu podatkov smo zasledili, da so bolniki iz skupine s pregabalinom uporabljali manj analgetikov ter dosegli večje izboljšanje stanja pri vseh kakovostih bolečine in spanja. Pri njih smo ugotovili tudi manj pojavov subakutne in postzostrne nevralgije. Nespecifična ocena zdravljenja, izražena kot celostna klinična ocena zdravljenja bolečine in izboljšanja stanja, je bila boljša v skupini bolnikov s pregabalinom. Ta skupina je zdravljenje bolečine ocenila kot zelo uspešno v 55 %, bolniki v skupini s placebom v 50 % primerov. Zelo uspešno izboljšanje stanja je navedlo 50 % bolnikov iz skupine s pregabalinom in 37 % iz skupine s placebom. Prenosljivost zdravila so bolje ocenili bolniki iz skupine s placebom. Zelo dobro prenosljivost zdravila je ocenilo 40 % bolnikov iz skupine s pregabalinom in 50 % bolnikov iz skupine s placebom. Slabo prenosljivost zdravila je ocenilo 30 % bolnikov iz skupine s pregabalinom in 28 % bolnikov iz skupine s placebom. Sklep V raziskavi nismo ugotovili statistično značilnega vpliva pregabalina na akutno zostrno nevralgijo. Pri tem smo upoštevali ocene jakosti in kakovosti bolečine, kakovosti življenja, pojava neželenih učinkov ter pojav subakutne zostrne nevralgije in postzostrne nev
Keywords:	zostrna bolezen, akutna nevralgija, postzostrna nevralgija, zdravljenje, pregabalin
Place of publishing:	Maribor
Year of publishing:	2010
PID:	20.500.12556/DKUM-39708
COBISS.SI-ID:	3652415
NUK URN:	URN:SI:UM:DK:AWTHVHO4
Publication date in DKUM:	19.02.2013
Views:	3516
Downloads:	260
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Categories:	MF
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Secondary language

Language:	English
Title:	The influence of pregabalin to acute zoster neuralgia
Abstract:	Acute herpetic neuralgia is characterized by a specific quality of pain in association with outbreak of a herpes zoster rash. The pain is associated with hyperalgesia, allodynia, burning sensation, prickling sensation, tingling sensation or an electric shock-like sensation, and usually disappears with rash regression. Pain may be severe and lasting and may turn into a chronic disease. Postherpetic neuralgia is a chronic neuropathic pain which is very resistant to treatment and significantly influences patients’ quality of life. For that reason, all efforts aimed at acute pain treatment and prevention of postherpetic neuralgia are very important. In the study we have evaluated the effect of pregabalin on alleviation on acute zoster neuralgia and onset of postherpetic neuralgia. Patients and Methods The clinical comparative study was designed as prospective randomized double-blind placebo controlled study. The study included outpatients who had a 7-14 day period of pain assessed to 4 and more points according to 11 point Likert scale. The patients were treated over three weeks with 150-300 mg pregabalin daily or with placebo. Pain was treated with naproxen, tramadol or oxycodone, as necessary and applicable. During the treatment we assessed pain, allodynia, hyperalgesia, burning, prickling, tingling, and electric-shock like sensation severity, quality of sleep and physical activity. We took notes on the consumption of analgesics as well as the manifestation of adverse events. Subacute herpetic neuralgia was assessed after three weeks of study treatment. Postherpetic neuralgia was assessed after 6 moths on the basis of phone interview. Results The study included 38 patients, among those were 20 patients in pregabalin group and 18 patients in placebo group. There were no statistically significant differences with respect to patients’ demographic data, dermatomal distribution and severity of rash, the use of antiviral therapy, or duration of acute zoster pain and study duration. Using standard statistical analyses we did not ascertain statistically significant differences between the groups as regards the intensity of pain, allodynia, hyperalgesia, burning, prickling, tingling and electric shock-like sensations, quality of sleep and physical activity. We ascertained statistically significant difference in average daily consumption of analgesics in morphine equivalent which was 15  12 mg in pregabalin group and 26  12 mg in placebo group. We also found no statistically significant difference in the occurrence of adverse events and the onset of subacute herpetic neuralgia and postherpetic neuralgia. In the percentage data analysis, we detected less use of analgesic in the pregabalin group as well as better improvement of allodynia, hyperalgesia, burning, prickling, tingling and electric shock –like sensations and less of subacute herpetic neuralgia and postherpetic neuralgia. Unspecific assessment of the treatment by patients, expressed as comprehensive assessment of drug efficacy and assessment of global improvement, was better in the pregabalin group. Very successful pain treatment was assessed by 55% of patients in the pregabalin group and by 50% of patients in the placebo group. Very successful improvement was assessed by 50% of patients in the pregabalin group and by 37% of patients in the placebo group. Medication tolerability was better assessed in placebo group. Very good tolerability of medication was assessed by 50% of patients in the placebo group and 40% of patients in the pregabalin group. Poor tolerability was assessed by 30% of patients in the pregabalin group and by 28% of patients in the placebo group. Conclusion Ther study did not prove any statistically significant effect of pregabalin in pain relief in patients with acute zoster pain with respect to pain intensity and quality, quality of life and adverse events. We found statistically significant difference in average daily analgesic consumption, expressed in morphine equivalent, which was lower in pregabalin group.
Keywords:	herpes zoster, acute neuralgia, postherpetic neuralgia, treatment, pregabalin

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