|
|
|
| Clinical efficacy and safety of Duloxetine Hydrochloride and Amitriptyline in patients with herpes zoster neuralgia |
| LI Xiaoqian LI Jing MA Chao HUANG Ying |
| Department of Pain Medicine, Drum Tower Hospital Affiliated to Nanjing University Medicine School, Jiangsu Province, Nanjing 210008, China |
|
|
|
|
Abstract Objective To compare the clinical efficacy and safety of Duloxetine Hydrochloride and Amitriptyline in patients with herpes zoster neuralgia. Methods A total of 120 patients with herpes zoster neuralgia admitted to the Department of Pain Medicine, Nanjing Drum Tower Hospital Affiliated Nanjing University Medical College from January to August 2022 were selected, they were divided into Amitriptyline group (60 cases, Amitriptyline combined with Pregabalin orally) and Duloxetine group (60 cases, Duloxetine Hydrochloride combined with Pregabalin orally) by random number table method. Visual analogue scale (VAS) scores were compared between two groups before treatment and at 7, 14 d, and 28 d after treatment; Hamilton depression scale 17 (HAMD-17) scores was compared between two groups before treatment and at 14 d and 28 d after treatment; Pittsburgh sleep quality index (PSQI) scores were compared between two groups before treatment and at 28 d after treatment; the dosage of Pregabalin at 28 d after treatment was compared between two groups; the occurrence of adverse reactions at 28 d after treatment was recorded in both groups. Results Two cases in Amitriptyline group and one case in Duloxetine group could not be effectively eliminated due to adjustment of dosage. The overall analysis showed that there were statistically significant differences in the time, inter-group, and interaction of VAS scores between two groups (P＜0.05). Further pairwise comparison, intra-group comparison: VAS scores of two groups at 7, 14 d, and 28 d after treatment were lower than those before treatment, and the differences were statistically significant (P＜0.05). Comparison between groups: VAS scores at 7, 14 d, and 28 d after treatment of Duloxetine group were lower than those of Amitriptyline group, and the differences were statistically significant (P＜0.05). Overall analysis showed that there was no significant difference in HAMD-17 score between two groups (P＞0.05). There were significant differences in HAMD-17 score time and interaction between two groups (P＜0.05). Further pairwise comparison, intra-group comparison: HAMD-17 scores at 14 d and 28 d after treatment of two groups were lower than those before treatment, and the differences were statistically significant (P＜0.05). Comparison between groups: there was no significant difference in HAMD-17 scores at 14 d and 28 d after treatment between two groups (P＞0.05). Before treatment, there was no significant difference in PSQI score between two groups (P＞0.05). At 28 d after treatment, PSQI scores in two groups were lower than those before treatment, and Duloxetine group was lower than Amitriptyline group, and the differences were statistically significant (P＜0.05). There was no significant difference in dosage of Pregabalin between two groups (P＞0.05). The incidence of dry mouth in Duloxetine group was lower than that in Amitriptyline group, and the difference was statistically significant(P＜0.05); there were no significant differences in the incidence of nausea, dizziness, lethargy, and palpitation between two groups (P＞0.05). Conclusion Duloxetine Hydrochloride combined with Pregabalin in the treatment of herpes zoster neuralgia has more accurate effect and higher safety, can effectively relieve pain and improve life quality, and is worthy of clinical application.
|
|
|
|
|
|
[1] Wang Q，Yang L，Li L，et al. Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions：Global Systematic Review and Meta-Analysis [J]. JMIR Public Health Surveill，2023，9：e43893.
[2] Cohen EJ. Commentary on Herpes Zoster and Postherpetic Neuralgia [J]. Clin Infect Dis，2021，73（9）：e3218-e3219.
[3] Zhou Z，Hu X，Yan F，et al. Observation on the effect of pla- telet-rich plasma combined with drugs in the treatment of herpes zoster neuralgia [J]. Int J Neurosci，2022：1-7.
[4] Kwon HJ，Kim DH，Cho SS，et al. Comparison of Adjuvant Hypertonic Saline and Normal Saline for Epidural Block in Patients with Postherpetic Neuralgia：A Double-Blind，Randomized Trial [J]. Pain Res Manag，2022，2022：8081443.
[5] 于生元，万有，万琪，等.带状疱疹后神经痛诊疗中国专家共识[J].中国疼痛医学杂志，2016，22（3）：161-167.
[6] Shrestha M，Chen A. Modalities in managing postherpetic neuralgia [J]. Korean J Pain，2018，31（4）：235-243.
[7] 陈潇，胡咏兵.普瑞巴林联合阿米替林治疗老年带状疱疹后遗神经痛的临床疗效[J].中国处方药，2019，17（7）：119-120.
[8] Jiang L，Xiong Y，Cui J. Comparison of the Efficacy and Safety of Duloxetine and Gabapentin in Diabetic Peripheral Neuropathic Pain：A Meta-Analysis [J]. Contrast Media Mol Imaging，2022，2022：4084420.
[9] Fan HR，Zhang EM，Fei Y，et al. Early Diagnosis of Herpes Zoster Neuralgia：A Narrative Review [J]. Pain Ther，2023， 12（4）：893-901.
[10] Geiger-Brown JM，Rogers VE，Liu W，et al. Cognitive beha- vioral therapy in persons with comorbid insomnia：A meta- analysis [J]. Sleep Med Rev，2015，23：54-67.
[11] Carney CE，Edinger JD，Kuchibhatla M，et al. Cognitive Behavioral Insomnia Therapy for Those With Insomnia and Depression：A Randomized Controlled Clinical Trial [J]. Sleep，2017，40（4）：zsx019.
[12] Zimmerman M，Martinez JH，Young D，et al. Severity classi- fication on the Hamilton Depression Rating Scale [J]. J Aff- ect Disord，2013，150（2）：384-388.
[13] Li J，Qu W，Hu C，et al. Antidepressants amitriptyline，fluo- xetine，and traditional Chinese medicine Xiaoyaosan caused alterations in gut DNA virome composition and function in rats exposed chronic unpredictable mild stress [J]. Front Micr- obiol，2023，14：1132403.
[14] Obradovic M，Vanden BH，Liedgens H. Cost-Effectiveness of the Lidocaine 5% Medicated Plaster Verse Pregabalin and Amitriptyline for the Treatment of Post-Herpetic Neuralgia In the Netherlands [J]. Value Health，2014，17（7）：A531.
[15] Bardin MG，Giraldo PC，Lenzi J，et al. Does the addition of electrical stimulation or kinesiotherapy improve outcomes of amitriptyline treatment for women with vulvodynia? A randomized clinical trial [J]. Int Urogynecol J，2023，34（6）： 1293-1304.
[16] Scheuermann K，Viana C，Dos RD，et al. Amitriptyline efficacy in decreasing implant-induced foreign body reaction [J]. IUBMB Life，2023，75（9）：732-742.
[17] Huang Y，Chen H，Chen SR，et al. Duloxetine and Amitriptyline Reduce Neuropathic Pain by Inhibiting Primary Sensory Input to Spinal Dorsal Horn Neurons via alpha1-and alpha2-Adrenergic Receptors [J]. ACS Chem Neurosci，2023， 14（7）：1261-1277.
[18] Wang D，Lai J，Lu S，et al. Rapid-onset hyponatremia and delirium following duloxetine treatment for postherpetic neu- ralgia：Case report and literature review [J]. Medicine（Baltimore），2018，97（46）：e13178.
[19] Wu CS，Huang YJ，Ko YC，et al. Efficacy and safety of duloxetine in painful diabetic peripheral neuropathy：a systematic review and meta-analysis of randomized controlled trials [J]. Syst Rev，2023，12（1）：53.
[20] Shah I，Ahmad W，Islam M，et al. A Prospective Observational Study Comparing the Efficacy and Safety of Duloxetine and Pregabalin in Diabetic Peripheral Neuropathic Pain [J]. Cureus，2022，14（9）：e28683.
[21] Chen Z，Shrestha N，Zhao C，et al. Effect of duloxetine prem- edication for postherpetic neuralgia within 72 h of herpes zoster reactivation [PROCESS]：a study protocol for a randomized controlled trial [J]. Trials，2020，21（1）：1012.
[22] Chow SP，Stevens S，Tran S，et al. Case Series：Synergistic Effect of Gabapentin and Adjuvant Pregabalin in Neuropathic Pain [J]. J Pain Palliat Care Pharmacother，2023，37（1）：106-109.
[23] Sane S，Aghdashi MM，Kazemi HB，et al. Corrigendum to：The Effect of Pregabalin on the Prevention of Succinylcholine-Induced Fasciculation and Myalgia. Journal of PeriAnesthesia Nursing，2020；35（3）：255-259 [J]. J Perianesth Nurs，2021，36（3）：319-320.
[24] 杨军，刘翠玲.普瑞巴林联合强的松治疗带状疱疹后神经痛的疗效及安全性[J].实用药物与临床，2014，17（8）：1012-1015.
[25] 冯晓波，张宗泽.普瑞巴林联合文拉法辛治疗带状疱疹后神经痛疗效观察[J].中华全科医学，2013，11（7）：1032- 1034. |
|
|
|
