Korean J Pain.  2021 Apr;34(2):210-216. 10.3344/kjp.2021.34.2.210.

Intravenous patient-controlled analgesia hydromorphone combined with pregabalin for the treatment of postherpetic neuralgia: a multicenter, randomized controlled study

• Huang Y
• Xu C
• Zeng T
• Li Z
• Xia Y
• Tao G
• Zhu T
• Lu L
• Li J
• Huang T
• Huai H
• Ning B
• Ma C
• Wang X
• Chang Y
• Mao P
• Lin J

• KMID: 2514425
• DOI: http://doi.org/10.3344/kjp.2021.34.2.210

Abstract

Background
Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN.
Methods
Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments.
Results
Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression.
Conclusions
IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

Keyword

Analgesia; Patient-Controlled; Analgesics; Opioid; Anticonvulsants; Hydromorphone; Neuralgia; Postherpetic; Opiate Alkaloids; Pain; Intractable; Pain Management; Pregabalin

Figure

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  Fig. 1 Assignment of patients to treatment groups.

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  Fig. 2 Effect of treatment on pain scores over time. The decline in the numerical rating scale (NRS) score over time in the hydromorphone group is significantly steeper than that in the control group after treatment (P < 0.001). Error bars indicate standard deviation. The asterisks indicate significant differences (***P < 0.001).

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  Fig. 3 Effect of treatment on the frequency of breakthrough pain over time. The frequency of breakthrough pain in the hydromorphone group is significantly lower than that in the control group one week and four weeks after treatment (P < 0.001). Error bars indicate standard deviation. The asterisks indicate significant differences (***P < 0.001).

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  Fig. 4 Mean pain quality scores (Short-Form McGill Pain Questionnaire, SFMPQ) over time. The mean SFMPQ score in the hydromorphone group is significantly decreased compared with the control group after treatment (P < 0.001). Error bars indicate standard deviation. The asterisks indicate significant differences (***P < 0.001). ns: no statistical difference.

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  Fig. 5 Pittsburgh sleep quality index (PSQI) in postherpetic neuralgia patients. The mean PSQI score in the hydromorphone group is significantly decreased compared with the control group after treatment (P < 0.001). Error bars indicate standard deviation. The asterisks indicate significant differences (***P < 0.001).

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