Objective: To investigate the efficacy and safety of high-voltage pulse radiofrequency combined with pregabalin on severe thoracic postherpetic neuralgia (PHN). Methods: A total of 103 patients with PHN who were admitted to the Department of Pain Medicine of Henan Provincial People's Hospital from May 2020 to May 2022 were retrospectively selected, including 50 males and 53 females, and aged 40 to 79 (65.4±9.2) years. The patients were divided into two groups according to the treatment methods they received: the control group (n=51) and the study group (n=52). The patients in the control group were treated with oral pregabalin, and the patients in the study group received pregabalin plus high-voltage pulse radiofrequency therapy. The pain intensity and efficacy of the two groups were evaluated before treatment and 4 weeks after treatment. The pain intensity, the sleep quality and the efficacy of treatment was evaluated by visual analogue scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score and nimodipine method, respectively. The levels of pain mediators including serum neuropeptide Y (NPY), prostaglandin E2 (PGE2), substance P (SP) and β-endorphin were measured. The differences of the above indicators and the incidence of adverse reactions were compared between the two groups. Results: The VAS scores of the study group and the control group before treatment were 7.94±0.76 and 8.20±0.81, and PSQI scores were 16.84±3.90 and 16.29±3.84, respectively, with no statistically significant differences (both P>0.05). After 4 weeks of treatment, the VAS scores of the two groups were 2.84±0.80 and 3.35±0.87, and PSQI scores were 6.78±1.90 and 7.98±2.40, respectively, and the VAS score and PSQI score in the study group were lower than those in the control group (both P<0.05). There were no significant differences of the serum levels of NPY, PGE2, SP and β-endorphin before treatment in the study group and control group (all P>0.05). After 4 weeks of treatment, the levels of NPY, PGE2, SP and β-Endorphin in the study group were (240.7±26.8) ng/L, (74.4±8.6) μg/L, (108.9±15.7) ng/L and (4.4±0.9) ng/L, which were lower than those in the control group [(268.1±29.4) ng/L, (79.7±8.3) μg/L, (115.2±16.2) ng/L, (5.2±1.3) ng/L, respectively], with statistically significant differences (all P<0.05). After treatment, 29 cases were cured, 16 cases were markedly effective and 6 cases were effective in the study group, while 16 cases, 24 cases and 8 cases were cured, markedly effective and effective in the control group, respectively. The overall efficacy of patients in the study group was better than that in the control group (Z=-2.32, P=0.018). The incidence of adverse reactions in the study group and control group was 11.5% (6/52) and 7.8% (4/51), respectively, with no statistically significant difference (χ2=0.40, P=0.527). Conclusion: High-voltage pulse radiofrequency combined with pregabalin can significantly improve the pain intensity and sleep quality of patients with severe thoracic PHN and reduce the levels of pain mediators, with a high safety profile.
目的： 探讨高电压脉冲射频联合普瑞巴林治疗重度胸段带状疱疹后神经痛（PHN）的疗效及安全性。 方法： 回顾性选取河南省人民医院疼痛科2020年5月至2022年5月收治的103例PHN患者，其中男50例，女53例，年龄40~79（65.4±9.2）岁。根据所接受的治疗方法将患者分为两组：对照组（n=51）和试验组（n=52）。对照组患者采用口服普瑞巴林进行治疗，试验组采用口服普瑞巴林+高电压脉冲射频治疗。分别于治疗前及治疗4周后对两组患者进行疼痛程度评估以及疗效评价，采用视觉模拟评分（VAS）进行疼痛程度评估，采用匹兹堡睡眠质量指数量表（PSQI）评分进行睡眠质量评价，采用尼莫地平法进行疗效评价；并检测两组患者治疗前后疼痛因子水平，包括血清神经肽Y（NPY）、前列腺素E2（PGE2）、P物质（SP）、β-内啡肽水平。对比两组患者上述指标的差异，以及不良反应发生率的差异。 结果： 试验组和对照组治疗前VAS评分分别为（7.94±0.76）、（8.20±0.81）分，PSQI评分分别为（16.84±3.90）、（16.29±3.84）分，治疗4周后VAS评分分别为（2.84±0.80）、（3.35±0.87）分，PSQI评分分别为（6.78±1.90）、（7.98±2.40）分；两组患者治疗前的VAS评分、PSQI评分差异均无统计学意义（均P>0.05）；治疗4周后，试验组患者的VAS评分和PSQI评分均低于对照组（均P<0.05）。试验组和对照组治疗前血清NPY、PGE2、SP、β-内啡肽水平差异均无统计学意义（均P>0.05）；治疗4周后，试验组NPY、PGE2、SP、β-内啡肽水平分别为（240.7±26.8）ng/L、（74.4±8.6）μg/L、（108.9±15.7）ng/L、（4.4±0.9）ng/L，均低于对照组的（268.1±29.4）ng/L、（79.7±8.3）μg/L、（115.2±16.2）ng/L、（5.2±1.3）ng/L（均P<0.05）。治疗4周后，试验组痊愈、显效、有效分别为29、16、6例，对照组分别为16、24、8例，试验组患者的总体疗效优于对照组（Z=-2.32，P=0.018）。试验组不良反应发生率为11.5%（6/52），对照组为7.8%（4/51），差异无统计学意义（χ2=0.40，P=0.527）。 结论： 高电压脉冲射频联合普瑞巴林能显著改善重度胸段PHN患者的疼痛及睡眠质量，降低疼痛因子水平，且安全性较好。.