2021年 · 第101卷第43期

Hydromorphone can replace morphine in the treatment of refractory cancer pain by intrathecal drug infusion system (IDDS), however, there is not sufficient clinical evidence to prove it. This study included 233 patients from 12 pain management centers in China who were randomized into two groups: intrathecal hydromorphone infusion group (ITHM,n=121) and the intrathecal morphine infusion group (ITMO,n=112）。 The primary outcome measure was clinical success, defined as the rate of ≥50% pain relief in patients. The non-inferiority margin (NIm) was 15%. Secondary outcome measures included daily visual analog scale of pain (VAS), incidence of burst pain (BTP), intrathecal drug dose, number of patient intravenous controlled analgesia (PCA) compressions, and anxiety and depression status (Patient Health Questionnaire Depression Scale PHQ-9, Generalized Anxiety Scale GAD-7). Clinical success was achieved in 85 (70.2%) and 79 (70.5%) of 121 patients with ITHM and 112 patients with ITMO, respectively. Patients in both groups had significant decreases in VAS scores and BTP incidence compared to the corresponding baseline. From Week 3 onwards, the rate of dose change decreased over time in the ITHM and ITMO groups (-3.33% vs. 35.4%,P<0.01）。 From week 1 onwards, the rate of change in the number of PCA compressions was lower in the ITHM group than in the ITMO group (-19.88% vs. 7.79%,P<0.01）。

Herpes zoster (HZ) is characterized by a vesicular rash accompanied by pain and mainly affects the elderly and immunocompromised people. The epidemiological data of HZ in China suggest that the relevant data of people over 50 years old who have not received HZ vaccine in China are still insufficient. This study aimed to evaluate the epidemiological characteristics, disease burden and associated risk factors of HZ in people aged ≥50 years in our country.

Postherpetic neuralgia (PHN) is a chronic pain caused by varicella zoster virus infection and is common in older adults. The typical clinical sign of PHN is a persistent tingling or burning pain with spontaneous pain that severely affects the quality of life of elderly patients. Its pathogenesis is complex and its treatment is difficult. Pulsed radio frequency (PRF) is a minimally invasive technique for applying a pulsed current to a target nerve. Recent studies have confirmed the beneficial effects of PRF on postoperative pain, peripheral neuropathological pain, and postherpetic neuralgia. The thoracic nerve (T1-12) is the most common site of PHN involvement, with an incidence of up to 50%. Studies have shown that both dorsal root ganglion (DRG) and intercostal nerve (ICN) in combination with PRF are effective in the treatment of thoracic postherpetic neuralgia. However, there have been no studies comparing the analgesic effects of these two methods in elderly patients. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided DRG or ICN for PRF modulation in the treatment of elderly PHN, and to provide theoretical basis for clinical treatment. Elderly patients were divided into two groups according to needle position: DRG group and ICN group. Visual analog scale (VAS) and brief health status questionnaire (SF-36) were used to assess the pain intensity and quality of life of patients before treatment and 2, 4, and 12 weeks after treatment, and the occurrence of adverse reactions during treatment was recorded.