曲马多治疗带状疱疹后疼痛。一项与氯丙咪嗪联合或不联合左旋美丙嗪的开放式试点研究结果]。
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郭贝尔，施塔德勒
曲马多治疗带状疱疹后疼痛。一项与氯丙咪嗪联合或不联合左旋美丙嗪的开放式试点研究结果]。
药物，1997;53增刊2:34-9。
- PubMed ID
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9190323 (PubMed视图］
- 摘要
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迄今为止，对于带状疱疹后神经痛患者的治疗没有普遍适用的建议。临床轶事、实验发现和临床试验观察的混合构成了这种情况的医疗武器库的基础。三环类抗抑郁药是常用的，临床经验和一些调查已经证明了它们的有效性。今天，单一实体抗抑郁药，可与神经阻滞剂联合使用以增加镇痛，通常被推荐用于带状疱疹后神经痛的治疗。一些作者还建议，如果镇痛不足，额外管理阿片类药物。就在十多年前，阿片类药物被认为对治疗神经性疼痛无效;然而，最近有关阿片类药物使用的研究，主要是在非肿瘤相关慢性疼痛的治疗中，导致了对其在神经性疼痛中的使用的修订。然而，使用阿片类药物治疗神经源性疼痛仍然存在争议。曲马多是一种合成的中枢作用镇痛药，具有阿片类和非阿片类镇痛活性。非阿片类成分与抑制去甲肾上腺素(去甲肾上腺素)再摄取和刺激血清素(5-羟色胺; 5-HT) release at the spinal level. In this regard, there are parallels with antidepressants, which are believed to potentiate the effect of biogenic amines in endogenous pain-relieving systems. There is evidence that, in tramadol, both mechanisms act synergistically with respect to analgesia. The aim of this pilot study was to investigate, for the first time, the analgesic efficacy and tolerability of tramadol, compared with the antidepressant clomipramine, in the treatment of postherpetic neuralgia. If necessary, clomipramine was used in combination with the neuroleptic levomepromazine. The study allowed individualised dosages at predetermined intervals up to a maximum daily dose of tramadol 600mg and clomipramine 100mg, or clomipramine 100mg with or without levomepromazine 100mg. 21 (60%) of 35 randomised patients (> or = 65 years) received the study medication over the 6-week period [tramadol n = 10; clomipramine with or without levomepromazine) n = 11]. After 3 weeks' treatment the dosage in both groups remained almost constant for the rest of the 6-week treatment phase (mean daily dose: tramadol 250 to 290mg; clomipramine 59.1 to 63.6mg). Only 3 patients required the combination of clomipramine and levomepromazine. At the outset, both groups recorded an average pain level of 'moderate' to 'very severe'. In correlation with increasing the study medication, this had decreased to 'slight' by the end of the treatment, when 9 of 10 patients in the tramadol group and of 6 of 11 patients in the clomipramine group retrospectively rated their analgesia as excellent, good or satisfactory. The psychological/physical condition of the patients did not change significantly during tramadol treatment. Sensitivity and depression parameters decreased in the clomipramine group. The incidence of adverse events for all patients was similar in both groups (tramadol 76.5%; clomipramine with or without levomepromazine 83.3%). In conclusion, tramadol would appear to be an interesting therapeutic alternative for pain relief in postherpetic neuralgia, particularly in patients who are not depressed. In clinical practice, tramadol and clomipramine can best be used differentially. For example, tramadol could be the drug of first choice in patients with obvious cardiovascular disease (not an uncommon problem in the > or = 65 year age group) in whom antidepressants are contraindicated, and similarly in patients in whom an antidepressant effect is not required. (ABSTRACT TRUNCATED)
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