Clinical Study Of Hydromorphone For Patient-controlled Subcutaneous Analgesia In Controlling Moderate And Severe Pain In Patients With Herpetic Neuralgia

Background The pain of herpes zoster neuralgia is severe.For some middle-aged and elderly patients,first-line treatment drugs often have poor analgesic effect.For patients with herpes zoster neuralgia who are difficult to tolerate pain and seriously affect their daily activities and sleep,short-term adequate analgesia is an important premise for the treatment of herpes zoster neuralgia.Objective In this study,hydromorphone controlled subcutaneous analgesia was used to control moderate to severe pain in patients with herpes neuralgia,and its effectiveness and safety were observedMethods Eighty patients with herpes neuralgia who met the diagnosis and exclusion criteria admitted to the pain department from January 10,2022 to December 10,2022 were selected and divided into hydromorphone PCSA combined with oral pregabalin group(group H)and pregabalin plus tramadol oral conventional treatment group(group B)according to random number table,with 40 cases in each group.The NRS scores and SF-MPQ scores of the two groups were observed before treatment(T0),4h after treatment(T1),12 h after treatment(T2),24 h after treatment(T3),72 h after treatment(T4)and 1w after treatment(T5).PSQI scores were observed before treatment(T0),24 h after treatment(T3),72 h after treatment(T4)and 1w after treatment(T5).The daily oral dosage of morphine equivalent(MME)was observed 24h(T3),72h(T4),and 1w(T5)after treatment,and the duration of withdrawal of opioid morphine after reaching the standard of stable analgesia in both groups.Adverse reactions were observed 24 h after treatment(T3),72 h after treatment(T4)and 1w after treatment(T5)in 2 groups.Quantitative pain analyzer was used to record the intuitive current threshold and pain threshold before treatment(T0)and 1w after treatment(T5).Results The withdrawal cases(2 cases in group H and 1 case in group B)were excluded,and the remaining 77 patients completed the experiment.(1)There were no differences in the general conditions of the two groups,including gender,age,duration of disease,pain attack regularity,pain distribution site and underlying diseases(P<0.05).There were 2 patients in group H and 11 patients in group B taking morphine hydrochloride tablets for relief and analgesia,respectively,and the difference was statistically significant(P<0.05).(2)NRS scores in group H decreased gradually at each observation time point after treatment(P<0.05).In group B,NRS scores decreased gradually at 12h(T2),24h(T3),72h(T4)and 1w(T5)after treatment(P<0.05).Compared with group B,NRS scores in group H were decreased at4h(T1),12h(T2),24h(T3)and 72h(T4)after treatment(P<0.05).(3)SF-MPQ scores in group H were decreased gradually at each observation time point after treatment(P<0.05).SF-MPQ scores in group B decreased at 72h(T4)and 1w(T5)after treatment(P<0.05).Compared with group B,SF-MPQ scores in group H were decreased at 4h(T1),12h(T2),24h(T3)and 72h(T4)after treatment(P<0.05).(4)PSQI scores in H group decreased gradually before treatment(T0),24 h after treatment(T3),72 h after treatment(T4)and 1w after treatment(T5)(P<0.05);PSQI score in group B decreased at 72 h after treatment(T4)(P<0.05).Compared with group B,PSQI scores in group H at 72h(T4)and 1w(T5)after treatment were lower than those in group B(P<0.05).(5)Compared with group B,the average daily oral MME in group H at 1w(T5)after treatment was decreased(P<0.05).The number of days of medication in group H was lower than that in group B(P<0.05).(6)Adverse reactions occurred in both groups to varying degrees during treatment.The incidence of dizziness,nausea and vomiting in group H was lower than that in Group B 24 h after treatment(T3)(P<0.05).Other adverse reactions,such as pruritus,constipation,urinary retention and drowsiness,were not significantly different between the two groups during treatment(P<0.05).(7)CPT in group H after treatment(P<0.05)was decreased compared with that before treatment(P<0.05),while that in group B was not significantly decreased(P<0.05).PT in 2groups had no significant change during treatment(P<0.05).Conclusion Compared with conventional treatment,hydromorphone controlled subcutaneous analgesia can relieve patients’ pain in the short term,improve sleep quality,reduce the incidence of central and peripheral sensitization,and reduce the use of opioid drugs,with good clinical effect and high safety.