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带状疱疹后神经痛

Authors
Zahid H Bajwa, MD
Carol A Warfield, MD
Dana G Crovo, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD

引言

水痘-带状疱疹病毒(varicella-zoster virus, VZV)是水痘和带状疱疹的病原体。大多数急性带状疱疹为自限性的，尽管疼痛能造成巨大的痛苦，尤其对于老年人。症状可严重到足以干扰睡眠、食欲或性功能。此外，在皮疹消退后，不同比例的患者还要继续忍受数月至数年的疼痛[即带状疱疹后神经痛(postherpetic neuralgia, PHN)]。PHN可能相当难治。

PHN传统上定义为皮疹消失后疼痛持续超过1个月。我们更喜欢一个不同的分类系统[1]：

  • 急性疱疹性神经痛是指疼痛开始于皮疹出现前或伴随皮疹出现且从发作起持续多达30日。
  • 亚急性疱疹性神经痛是指疼痛在皮疹治愈后仍持续，但在发作后4个月内消退。
  • PHN是指疼痛从皮疹发作开始起持续超过4个月。

PHN的流行病学、发病机制、临床特点和治疗将总结在此。VZV的其他方面信息以及带状疱疹感染的急性治疗将单独讨论。 (参见“Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster”和“免疫功能正常宿主带状疱疹的治疗”)

流行病学/危险因素

急性带状疱疹感染的发病率随着年龄、疾病或化疗造成的免疫系统损伤而增加。20岁以下健康人群的每年发病率约为1/1000，而80岁以上人群的发病率高5-10倍[2]。在癌症或HIV感染患者中，带状疱疹发病率更高[3]。 (参见“Epidemiology and pathogenesis of varicella-zoster virus infection: Herpes zoster”, section on ‘Epidemiology’)

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-02-13.
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References
Top
  1. Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster. Pain 1996; 67:241.
  2. Glynn C, Crockford G, Gavaghan D, et al. Epidemiology of shingles. J R Soc Med 1990; 83:617.
  3. Rusthoven JJ, Ahlgren P, Elhakim T, et al. Varicella-zoster infection in adult cancer patients. A population study. Arch Intern Med 1988; 148:1561.
  4. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. BMJ 2000; 321:794.
  5. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352:2271.
  6. Dworkin RH, Boon RJ, Griffin DR, Phung D. Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. J Infect Dis 1998; 178 Suppl 1:S76.
  7. Nagasako EM, Johnson RW, Griffin DR, Dworkin RH. Rash severity in herpes zoster: correlates and relationship to postherpetic neuralgia. J Am Acad Dermatol 2002; 46:834.
  8. Whitley RJ, Weiss HL, Soong SJ, Gnann JW. Herpes zoster: risk categories for persistent pain. J Infect Dis 1999; 179:9.
  9. Jung BF, Johnson RW, Griffin DR, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology 2004; 62:1545.
  10. Ragozzino MW, Melton LJ 3rd, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982; 61:310.
  11. Balfour HH Jr. Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management. Am J Med 1988; 85:68.
  12. Burke BL, Steele RW, Beard OW, et al. Immune responses to varicella-zoster in the aged. Arch Intern Med 1982; 142:291.
  13. Meier JL, Straus SE. Comparative biology of latent varicella-zoster virus and herpes simplex virus infections. J Infect Dis 1992; 166 Suppl 1:S13.
  14. Denny-Brown D, Adams RD, Fitzgerald PJ. Pathologic features of herpes zoster: A note on 'geniculate herpes'. Arch Neurol Psychiatr 1944; 51:216.
  15. Head H, Campbell AW. The pathology of herpes zoster and its bearing on sensory localization. Brain 1900; 23:353.
  16. ZACKS SI, ELLIOTT FA, LANGFITT TW. HERPETIC NEURITIS: A LIGHT AND ELECTRON MICROSCOPIC STUDY. Neurology 1964; 14:744.
  17. Watson CP, Deck JH, Morshead C, et al. Post-herpetic neuralgia: further post-mortem studies of cases with and without pain. Pain 1991; 44:105.
  18. Watson CP, Morshead C, Van der Kooy D, et al. Post-herpetic neuralgia: post-mortem analysis of a case. Pain 1988; 34:129.
  19. Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth 1989; 63:139.
  20. LaMotte RH, Shain CN, Simone DA, Tsai EF. Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms. J Neurophysiol 1991; 66:190.
  21. Simone DA, Baumann TK, LaMotte RH. Dose-dependent pain and mechanical hyperalgesia in humans after intradermal injection of capsaicin. Pain 1989; 38:99.
  22. Cline MA, Ochoa J, Torebjörk HE. Chronic hyperalgesia and skin warming caused by sensitized C nociceptors. Brain 1989; 112 ( Pt 3):621.
  23. Bennett GJ. Hypotheses on the pathogenesis of herpes zoster-associated pain. Ann Neurol 1994; 35 Suppl:S38.
  24. Acosta EP, Balfour HH Jr. Acyclovir for treatment of postherpetic neuralgia: efficacy and pharmacokinetics. Antimicrob Agents Chemother 2001; 45:2771.
  25. Drolet M, Brisson M, Schmader KE, et al. The impact of herpes zoster and postherpetic neuralgia on health-related quality of life: a prospective study. CMAJ 2010; 182:1731.
  26. Johnson RW, Bouhassira D, Kassianos G, et al. The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med 2010; 8:37.
  27. Watson CP, Evans RJ, Watt VR, Birkett N. Post-herpetic neuralgia: 208 cases. Pain 1988; 35:289.
  28. Bowsher D. Pathophysiology of postherpetic neuralgia: towards a rational treatment. Neurology 1995; 45:S56.
  29. Schott GD. Triggering of delayed-onset postherpetic neuralgia. Lancet 1998; 351:419.
  30. Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med 2011; 123:134.
  31. Dubner R, Bennett GJ. Spinal and trigeminal mechanisms of nociception. Annu Rev Neurosci 1983; 6:381.
  32. Basbaum AI, Fields HL. Endogenous pain control mechanisms: review and hypothesis. Ann Neurol 1978; 4:451.
  33. Watson CP, Evans RJ, Reed K, et al. Amitriptyline versus placebo in postherpetic neuralgia. Neurology 1982; 32:671.
  34. Max MB, Schafer SC, Culnane M, et al. Amitriptyline, but not lorazepam, relieves postherpetic neuralgia. Neurology 1988; 38:1427.
  35. Watson CP, Vernich L, Chipman M, Reed K. Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Neurology 1998; 51:1166.
  36. DasGupta K. Treatment of depression in elderly patients: recent advances. Arch Fam Med 1998; 7:274.
  37. Kishore-Kumar R, Max MB, Schafer SC, et al. Desipramine relieves postherpetic neuralgia. Clin Pharmacol Ther 1990; 47:305.
  38. Moore RA, Wiffen PJ, Derry S, McQuay HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2011; :CD007938.
  39. Edelsberg JS, Lord C, Oster G. Systematic review and meta-analysis of efficacy, safety, and tolerability data from randomized controlled trials of drugs used to treat postherpetic neuralgia. Ann Pharmacother 2011; 45:1483.
  40. Dubinsky RM, Kabbani H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004; 63:959.
  41. Kochar DK, Garg P, Bumb RA, et al. Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled study. QJM 2005; 98:29.
  42. Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280:1837.
  43. Rice AS, Maton S, Postherpetic Neuralgia Study Group. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001; 94:215.
  44. Irving G, Jensen M, Cramer M, et al. Efficacy and tolerability of gastric-retentive gabapentin for the treatment of postherpetic neuralgia: results of a double-blind, randomized, placebo-controlled clinical trial. Clin J Pain 2009; 25:185.
  45. Wallace MS, Irving G, Cowles VE. Gabapentin extended-release tablets for the treatment of patients with postherpetic neuralgia: a randomized, double-blind, placebo-controlled, multicentre study. Clin Drug Investig 2010; 30:765.
  46. Medical Letter. Once-daily gabapentin (Gralise) for postherpetic neuralgia. Med Lett Drugs Ther 2011; 53:94.
  47. Sang CN, Sathyanarayana R, Sweeney M, DM-1796 Study Investigators. Gastroretentive gabapentin (G-GR) formulation reduces intensity of pain associated with postherpetic neuralgia (PHN). Clin J Pain 2013; 29:281.
  48. Dworkin RH, Corbin AE, Young JP Jr, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2003; 60:1274.
  49. Sabatowski R, Gálvez R, Cherry DA, et al. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomised, placebo-controlled clinical trial. Pain 2004; 109:26.
  50. Pregabalin (lyrica) for neuropathic pain and epilepsy. Med Lett Drugs Ther 2005; 47:75.
  51. Max MB, Schafer SC, Culnane M, et al. Association of pain relief with drug side effects in postherpetic neuralgia: a single-dose study of clonidine, codeine, ibuprofen, and placebo. Clin Pharmacol Ther 1988; 43:363.
  52. Rowbotham MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology 1991; 41:1024.
  53. Raja SN, Haythornthwaite JA, Pappagallo M, et al. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2002; 59:1015.
  54. Boureau F, Legallicier P, Kabir-Ahmadi M. Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Pain 2003; 104:323.
  55. Watson CP, Evans RJ, Watt VR. Post-herpetic neuralgia and topical capsaicin. Pain 1988; 33:333.
  56. Derry S, Sven-Rice A, Cole P, et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2013; :CD007393.
  57. Backonja M, Wallace MS, Blonsky ER, et al. NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomised, double-blind study. Lancet Neurol 2008; 7:1106.
  58. Wolff RF, Bala MM, Westwood M, et al. 5% lidocaine-medicated plaster vs other relevant interventions and placebo for post-herpetic neuralgia (PHN): a systematic review. Acta Neurol Scand 2011; 123:295.
  59. Kotani N, Kushikata T, Hashimoto H, et al. Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med 2000; 343:1514.
  60. Kikuchi A, Kotani N, Sato T, et al. Comparative therapeutic evaluation of intrathecal versus epidural methylprednisolone for long-term analgesia in patients with intractable postherpetic neuralgia. Reg Anesth Pain Med 1999; 24:287.
  61. Wu LJ, Zhuo M. Targeting the NMDA receptor subunit NR2B for the treatment of neuropathic pain. Neurotherapeutics 2009; 6:693.
  62. Chizh BA, Headley PM. NMDA antagonists and neuropathic pain--multiple drug targets and multiple uses. Curr Pharm Des 2005; 11:2977.
  63. Kristensen JD, Svensson B, Gordh T Jr. The NMDA-receptor antagonist CPP abolishes neurogenic 'wind-up pain' after intrathecal administration in humans. Pain 1992; 51:249.
  64. Eide PK, Jørum E, Stubhaug A, et al. Relief of post-herpetic neuralgia with the N-methyl-D-aspartic acid receptor antagonist ketamine: a double-blind, cross-over comparison with morphine and placebo. Pain 1994; 58:347.
  65. Nelson KA, Park KM, Robinovitz E, et al. High-dose oral dextromethorphan versus placebo in painful diabetic neuropathy and postherpetic neuralgia. Neurology 1997; 48:1212.
  66. Barnard D, Lloyd J, Evans J. Cryoanalgesia in the management of chronic facial pain. J Maxillofac Surg 1981; 9:101.
  67. Jones MJ, Murrin KR. Intercostal block with cryotherapy. Ann R Coll Surg Engl 1987; 69:261.
  68. Baranowski AP, De Courcey J, Bonello E. A trial of intravenous lidocaine on the pain and allodynia of postherpetic neuralgia. J Pain Symptom Manage 1999; 17:429.
  69. Hempenstall K, Nurmikko TJ, Johnson RW, et al. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLoS Med 2005; 2:e164.
  70. Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 2010; 17:1113.